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Confirmed hyperthyroidism. Prescribed Thyrozol. Planning for baby. Continue medication? Can I take Selenious Yeast tablets during pregnancy?

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Hi, I've been confirmed to have hyperthyroidism in the end of XXXXXXX 2012 and started to take medicine since then. At that time, all of the indexes were abnormal including extremely high Anti-TPO (>1300) nd Anti-TG (>500). After three months treatment with Thyrozol, everything returned to normal level. Then I took less and less Thyrozol according to doctor's suggestion based on monthly blood test results. Since XXXXXXX 2013, I took 1/4 tablet of Thyrozol every day. Starting from mid May, I stopped to take Thyrozol as is suggested by two doctors. My FT3/FT4/TSH have been very stable at the normal levels (TSH<2.5) since Oct 2012, but antibodies went back to extremely high levels in 2013. Also, TRAB rises to 7.3 in XXXXXXX I'd like to get pregnant later this year.
1) Do you think I should continue taking no medicine according to the current status? Or should I go back to the stage of taking minimum amount of Thyrozol?
2) If the latter, when would be a good timing to think about having baby.
3) My doctor gave me some Selenious Yeast tablets. Can I take them before/during pregnancy?

Many thanks!
Posted Tue, 16 Jul 2013 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Shehzad Topiwala 1 hour later
It appears you likely have Hyperthyroidism from Graves disease. TRABs are typically positive in Graves disease.
Graves is known to undergo spontaneous remission over time. Based on the information you have provided it seems this is occurring with you now. This is a good sign. As long as the blood tests for thyroid such as TSH, free T4 , total T3 , Total t4 and T3 resin uptake are within normal limits, it is acceptable to stay off Thyrozol. However it is important to monitor it periodically to ensure there is no re-appearance of the condition, as can and doses happen sometimes.
So initially I recommend testing every 6 weeks (sooner if you experience symptoms suggestive of an overactive thyroid) and less frequently thereafter to ensure stable long term remission.

Regarding your intent to become pregnant, it is best you are under regular care of a reproductive endocrinologist, or if this specialty does not exist in your country , then see an endocrinologist as well as a obstetrician.
there are few important considerations here:
1 Methimazole is not recommended in the first 3 months of pregnancy. Instead, PTU (propyl thiouracil) is. I dont know exactly which one of these two thyrozol is. It could be carbimazole too but it clearly appears to be some type of thionamide which is a category of medications used worldwide for hyperthyroidism.

2 It is important your thyroid levels are normal before and during pregnancy, regardless of whether you are on medication or not

3 Even if your thyroid levels are normal, TRABs can potentially affect the baby. Therefore it is important to monitor the fetus. This can be done by specialized doctors only

For more information, peruse these weblinks:

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Above answer was peer-reviewed by
 
Follow-up: Confirmed hyperthyroidism. Prescribed Thyrozol. Planning for baby. Continue medication? Can I take Selenious Yeast tablets during pregnancy? 10 hours later
Thanks for your prompt reply! I've been doing regular blood check on FT3/FT4/TSH/Anti-TPO/Anti-TG/TRAB and seeing endocrinologist every month since last XXXXXXX My report is attached.

Here're some follow-up questions.

1. By reading my report, are you more sure that mine could be Graves disease?

2. Does Graves disease mean that it will turn to be hypothyroidism
sooner or later?

3. I was told that high TRAB represents high rate of reaccurance. Is it true?

4. Is there any medicine I should take to control Anti-TPO, Anti-TG and TRAB?

5. When you say "It is important your thyroid levels are normal before and during pregnancy", do thyroid levels include Anti-TPO, Anti-TG and TRAB or just T3, T4 and TSH?

6. Can hyperthyroidism case loss in bone density? I was confirmed to have hyperthyroidism last XXXXXXX and had been taking medicine until last month. I did a bone density check today and was told it's a little bit low although not too serious. What should I do other than taking calcium tablets?

7. I don't have pop eye but my neck gets a little bit bigger. Will the pop eye sypotom develop later on? Can my neck go back to normal?

Btw, I think the medicine I took was Methimazole produced by Merck. It's quite effective on me with little side effects. I know that it could harm the baby so I did abortion last year suggested by my doctor. FYI.

Thank you very much!
 
 
Answered by Dr. Shehzad Topiwala 8 hours later
I read your lab reports. Here are my responses:

1. By reading my report, are you more sure that mine could be Graves disease?

quite likely, although the best way to determine this is to perform a test called 'Radioactive iodine 123 uptake and scan'

2. Does Graves disease mean that it will turn to be hypothyroidism
sooner or later?

Not necessarily

3. I was told that high TRAB represents high rate of reoccurence. Is it true?

There is some data to suggest this may be true

4. Is there any medicine I should take to control Anti-TPO, Anti-TG and TRAB?

Sometimes steroids like prednisone are used to control the auto-immune response, in particular from the TRABs

5. When you say "It is important your thyroid levels are normal before and during pregnancy", do thyroid levels include Anti-TPO, Anti-TG and TRAB or just T3, T4 and TSH?


TSH, T3 and T4 definitely need to be normalized. The antibodies are more challenging to manage

6. Can hyperthyroidism case loss in bone density? I was confirmed to have hyperthyroidism last XXXXXXX and had been taking medicine until last month. I did a bone density check today and was told it's a little bit low although not too serious. What should I do other than taking calcium tablets?

Treating hyperthyroidism will stop the bone loss from the overactive thyroid hormones


7. I don't have pop eye but my neck gets a little bit bigger. Will the pop eye symptom develop later on? Can my neck go back to normal?

Eye disease in Grave's can follow an independent course. Follow the guidance of your endocrinologist

Above answer was peer-reviewed by
 
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