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Was on neomarcazole switched to PTU for conception and had miscarriage. Told to switch again. Thyroid issue. Suggest?

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Hi doc , my problem is dat I was taking neomarcazole for nearly 3 years but XXXXXXX switched to ptu as I was planning for a baby and it was staying normal with one n half of a ptu XXXXXXX I had a miscarriage n I changed my doc who advices me to change to neomarcazole 10 mg for 3 months and my results now is tsh 0.009 t4 29 n t3 10.97 plz advice
Posted Tue, 8 Oct 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 3 hours later
Brief Answer:
You need to control your hyperthyroidism

Detailed Answer:
You need systematic assessment and management for your thyroid. I would like to give you detailed guidance but could you please send me a copy of your lab. I know you have mentioned the numbers above but I would like to see the ranges for normal in your laboratory. And if there is any CBC , liver and kidney tests available
Above answer was peer-reviewed by
Follow-up: Was on neomarcazole switched to PTU for conception and had miscarriage. Told to switch again. Thyroid issue. Suggest? 7 hours later
dear dr,
Kindly find below the table with the histroy of blood test and the limits kindly give me your email id so i can upload the file as it is in excle

Date     TSH     FT3     FT4     T3     T4     Place of test     Tablets Changed to     Tablets taken during blood test               Low     High     Low     High     Low     High     Low     High     Low     High
9-Sep-10     0.01               338.66     13.9     Religare                         0.35     5.5                         60     181     4.5     12.6
9-Oct-10     0.017     0.479     1.91               Shifa     Neomarcazol 15mg per day          3X5          0.27     4.2     0.182     0.462     0.932     1.71                    
27-Dec-10     0.122     0.41     0.92               Shifa     Neomarcazol 10mg per day     Neomarcazol 15mg per day     3X2     Doctor change     0.27     4.2     0.182     0.462     0.932     1.71                    
24-Jan-11     6.76               2.22     95.02     Shifa     Stopped     Neomarcazol 10mg per day               0.27     4.2                         1.3     3.1     66     181
8-Mar-11     0.017     1.64     5.92               Shifa     Neomarcazol 15mg per day     Stopped     3X5     Old doctor     0.27     4.2     0.182     0.462     0.932     1.71                    
6-May-11     0.005     0.517     2.17               Shifa     Neomarcazol 30mg per day     Neomarcazol 15mg per day     3X10          0.27     4.2     0.182     0.462     0.932     1.71                    
2-Jul-11     0.008     0.357     0.841               Shifa     Neomarcazol 30mg per day     Neomarcazol 30mg per day     3X10          0.27     4.2     0.182     0.462     0.932     1.71                    
7-Jul-11     0.01     5.1     11.5               AMH     Neomarcazol 30mg per day     Neomarcazol 30mg per day     3X10          0.27     4.2     3.5     6.5     10     23                    
30-Aug-11     4.687     2.7     0.82               Religare     Neomarcazol 30mg per day     Neomarcazol 30mg per day     3X10          0.35     5.5     2.3     4.2     0.89     1.76                    
6-Oct-11     47.429     2.19     0.57               Religare     Changed tablets     Neomarcazol 30mg per day          Doctor change     0.35     5.5     2.3     4.2     0.89     1.76                    
31-Oct-11     0.065     12.59     3.75               Religare     Neomarcazol 10mg per day          1X10     Old doctor     0.35     5.5     2.3     4.2     0.89     1.76                    
2-Dec-11     0.024     3.56     1.2               Religare     Neomarcazol 20mg per day     Neomarcazol 10mg per day     2X10     For 25 days PTU 50 X 2 was taken then Neomarcazol     0.35     5.5     2.3     4.2     0.89     1.76                    
6-Jan-12     0.004     4.51     1.37               Religare     Neomarcazol 30mg per day     Neomarcazol 20mg per day     3X10          0.35     5.5     2.3     4.2     0.89     1.76                    
12-Mar-12     0.008     4.2     0.94               Religare     Neomarcazol 30mg per day     Neomarcazol 30mg per day     3X10          0.35     5.5     2.3     4.2     0.89     1.76                    
16-Jun-12     6.706     2.93     0.66               Religare     Neomarcazol 30mg per day     Neomarcazol 30mg per day     3X10          0.35     5.5     2.3     4.2     0.89     1.76                    
18-Jul-12     17.477     2.88     0.61               Religare     Neomarcazol 10mg per day     Neomarcazol 30mg per day     2X5          0.35     5.5     2.3     4.2     0.89     1.76                    
27-Oct-12     0.534     0.216     0.946               Shifa     Neomarcazol 10mg per day     Neomarcazol 10mg per day     2X5          0.27     4.2     0.182     0.462     0.932     1.71                    
11-Dec-12     4.78     2.55     11.49               Semerra     PTU 75mg per day     Neomarcazol 10mg per day     1X10          0.25     5     2.2     4.2     9     20                    
3-Jan-13     1.071     3.18     0.94               Religare     PTU 100mg per day     PTU 75mg per day     1.5X50          0.35     5.5     2.3     4.2     0.89     1.76                    
29-Jan-13     3.95     2.5     9.59               Semerra     PTU 75mg per day     PTU 100mg per day     2X50                                                       
9-Apr-13     1.51     5.1     13.7               Semerra                    In a week 4 days 75 mg and 3 days 100 mg                                                  
2-Jun-13     0.497     3.62     1.26               Bugshan          PTU 75mg per day                                                            
8-Jul-13     0.07     4.34     1.36               Religare     PTU 75mg per day     Neomarcazol 10mg per day     2X5     Doctor change (Neuman Correia)     0.35     5.5     2.3     4.2     0.89     1.76                    
10-Sep-13     0.05     12.5     48.76               Semerra     Neomarcazol 10mg per day                    0.25     5     4     8.3     10.6     19.4                    
13-Sep-13     0.0008     10.97     29.62               DSFH                         0.35     4.94     2.6     5.7     9     19                    
Answered by Dr. Shehzad Topiwala 38 minutes later
Brief Answer:
PTU is preferred in the first trimester

Detailed Answer:
Neomercazole is generally recommended over PTU because recently it was shown that there can life threatening liver failure form PTU. However, this is rare but unfortunately there may occur without warning. Hence the latest thyroid guidelines advise that PTU use should be avoided except in the first 3 months of pregnancy. The reason for this is that carbimazole can cause birth defects. But it is ok to switch back to carbimazole after the first 3 months.
When I see patients like this in your situation, I generally first control their hyperthyroidism before they get pregnant. Ideally it is best to get definitive treatment such as radiation or surgery. The ensuing hypothyroidism is relatively easier to manage before and during pregnancy.
I strongly suggest you see a thyroid specialist/endocrinologist for close monitoring of this condition. The TSH should be normalized along with thyroid hormone levels.

You may wish to peruse this information for further understanding

Above answer was peer-reviewed by
Follow-up: Was on neomarcazole switched to PTU for conception and had miscarriage. Told to switch again. Thyroid issue. Suggest? 10 hours later
i am planning for a pregency i am only 29 years is doing XXXXXXX will effect my pregency? is it safe to have a child after RAI?
Answered by Dr. Shehzad Topiwala 7 hours later
Brief Answer: XXXXXXX is deemed safe

Detailed Answer: XXXXXXX is worth considering. It is the most commonly chosen treatment option for hyperthyroidism in USA.

However, careful patient selection is necessary.

Read this for further information:

Above answer was peer-reviewed by
Follow-up: Was on neomarcazole switched to PTU for conception and had miscarriage. Told to switch again. Thyroid issue. Suggest? 13 minutes later
after doing XXXXXXX can i be pregnant? how long i need to wait to be pregnant? do i need to take tablets after RAI? What are the pros and cons of XXXXXXX compared with other treatments? When may I return to work after XXXXXXX treatment? After treatment, how long should I avoid close contact with my family members? can you give me a detail guidance on whether to do or not to do XXXXXXX in my case?
Answered by Dr. Shehzad Topiwala 23 hours later
Brief Answer:
Weigh your options carefully

Detailed Answer:
Pregnancy and breastfeeding are absolute no-no to radioiodine therapy. A pregnancy test should be obtained in women of child-bearing age before the administration of radioiodine

Pregnancy should be delayed four to six months after radioiodine therapy to ensure that hyperthyroidism is successfully cured and hypothyroidism corrected prior to conception

Patients who receive radioiodine have the potential to expose their home and household contacts via saliva, urine, or radiation emitting from their body. They should be instructed to avoid the following during the restricted period:

Sharing cups or utensils
Sleeping in the same bed with another adult, pregnant woman, infant, or child
Sexual contact
Close contact with children and pregnant women

The period of post-treatment precaution varies with the dose administered and retained (table 1) [45,46]. In the United States, close daytime contact with adults should be avoided for approximately one, two, and five days, and sleeping with another adult should be avoided for approximately three, six, eight, and 11 days for doses of 10, 15, 20, and 30 mCi (370, 555, 740, 1110 MBq), respectively. The period of contact precautions for pregnant partners, infants, and children is longer (one to five days for daytime restrictions and 15 to 23 days for nighttime restrictions)

Hyperthyroidism can be treated with:

Medicines – Two types of medicines can be used to treat hyperthyroidism:

Anti-thyroid medicines reduce the amount of hormone your thyroid gland makes.
Beta-blocker medicines help reduce the symptoms of hyperthyroidism. Beta-blockers can make you more comfortable until the thyroid imbalance is under control.

Radioactive iodine – Radioactive iodine comes in a pill or liquid you swallow. It destroys much of the thyroid gland. Pregnant women should not use this treatment, because it can damage the baby’s thyroid gland. But the treatment is safe for women who are not pregnant and for men. The amount of radiation used is small. It does not increase the chance of getting cancer, and it does not cause problems getting pregnant in the future or increase the risk of birth defects in future pregnancies.

Surgery – Doctors can do surgery to remove part or all of the thyroid gland. Doctors do not often recommend surgery, because the other treatment choices are safer and less costly. But surgery is the best choice in some cases.

Most people who are treated with radioactive iodine or who have surgery end up making too little thyroid hormone after treatment. They must take thyroid hormone pills after treatment—for the rest of their life.

If you take anti-thyroid medicine, talk to your doctor or nurse before you start trying to get pregnant. You will probably need to take different medicines at different times in your pregnancy. Plus, your doses may need to be adjusted.

If you were treated with radioactive iodine, wait at least 6 months before you start trying to get pregnant. This will give your doctor enough time to find out if your thyroid is making enough thyroid hormone after the radioactive iodine treatment. If the radioactive iodine caused the thyroid to make too little thyroid hormone, you will need to take thyroid hormone pills. It is important to have a normal amount of thyroid hormone in your body before getting pregnant.

Whatever treatment you use, you should have your thyroid hormone levels checked often during pregnancy. Thyroid hormone levels must be at the right level during pregnancy to avoid risks to both the mother and the baby.

Above answer was peer-reviewed by
Follow-up: Was on neomarcazole switched to PTU for conception and had miscarriage. Told to switch again. Thyroid issue. Suggest? 3 hours later
what is the right amount of thyroid hormone levels during pregnancy
Answered by Dr. Shehzad Topiwala 8 hours later
Brief Answer:
Varies from lab to lab

Detailed Answer:
The normal ranges for thyroid hormone levels depend on the laboratory you go to. They have their own reference ranges for each trimester of pregnancy. They specify this at the time of reporting the result
Above answer was peer-reviewed by
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