# Need advice on best treatment for TTC as soon as possible



## christina20003 (Sep 27, 2011)

I was diagnosed with graves in May 2010. My PCP noticed high blood pressure when I went for a physical. She did labs and sent me to an endo who diagnosed. I've been on meds since (methimazole), and haven't been back to the endo in awhile. I know it's bad to be taking the meds without being monitored, but it's done. I went back to my PCP last week and she referred me to a new endo. I have an appointment next week. I am ready for a more permanent treatment and have been leaning towards surgery based on some of the stories I've read about RAI and people needing multiple treatments, etc.

I'll be 37 next month with no children, and my husband and I were trying to conceive(TTC) for 2 years before I was diagnosed. He was tested and has a very low sperm count, morphology, and volume. His doctor says we will probably need IVF to have a baby. I talked my company into adding insurance benefits for infertility beginning January 1, 2012, but I'm not confident that they will keep them for the long term due to the extra cost.

My question is what would be the better treatment for being able to undergo infertility treatments sooner. My ob ran some tests on me and didn't find anything other than the thyroid issues I already knew about. I've read that you don't have to wait as long for TTC after surgery because you can get your levels under control quicker. I would love any advice especially if you were in a similar situation and were able to have a baby shortly after treatment.


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## Octavia (Aug 1, 2011)

I don't know what TTC is, but if I were in your situation and wanted to have a baby soon, I would opt for surgery. With RAI, you may need more than one treatment, so that will set you back, time-wise. Given your rush and your suspicion about the long-term infertility coverage, I would say surgery is your best bet.


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## webster2 (May 19, 2011)

Hmmm....I am not sure if this is helpful, or not. I had half removed and 2 days short of the one year date of the surgery I had a baby...who just turned twenty last week. I realize now that I had an undiagnosed thyroid problem long before the surgery, it effected fertility and the ability to carry a pregnancy to term.

I am not sure how the Graves would come into play regarding a pregnancy. I had the remaining portion of my thyroid removed this past summer because of Graves. My symptoms are gone and my thyroid levels are in range. I am fatigued and do not have the stamina I think I should have, but it is a vast improvement over how I felt before.

Best wishes to you!


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## Alicia123 (Oct 7, 2011)

I dont have any answers for you but wish you lots of luck TTC (trying to conceive). Tend to that thyroid first!! Welcome to the boards.


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## christina20003 (Sep 27, 2011)

Thanks for the advice ladies. I definitely plan on tending to my thyroid before moving forward with trying to conceive. I'm just hoping that we can move forward with infertility treatments as soon as possible.

Do you think it's unreasonable to want to be trying within 3-4 months of treatment? That is why I'm leaning towards surgery, but I don't even know if that is something the new endo will be for or not. From what I've read, most endos push RAI. My PCP says this endo is one of the best in the area, so hopefully he will make all the options available to me. I read this in an article by the Graves Disease Foundation:

_"Since Graves' disease can be resolved quickly on a temporary
basis with medical therapy, what are "urgent" reasons for
risking surgery? We suggest the following non-inclusive list:
(1) Desire for pregnancy in late phase of reproductive life;..."_​


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## Linty (Aug 25, 2011)

Christina, i've done the surgery (with the advice of my endo and surgeon) due to TTC. With the methazole you will battle to get pg and its not safe during the pregnancy. So we decided on the surgery. After rai you will have to wait for at least 12 mths before trying and like Octavia said you would be lucky if its only one RAI. I am 8 weeks post surgery and got the go ahead from surgeon for ttc. I am waiting now...........:winking0051: hopefully....

They started me on meds the day after op and i still battle with some nasty symptoms like tiredness and getting jittery sometimes. 
I am most of the time glad i did the surgery.
Hope you get all the answers soon and hold your little miracle in no time.
:hugs:arty0030:


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## christina20003 (Sep 27, 2011)

Thanks, Linty. I hope you can get pg soon. That info is helpful. I didn't realize I would have to wait 12 months after RAI. Wow. That definitely makes the surgery option more appealing. I've been reading some about the possible complications from surgery, like the calcium issues. Did you have any complications or have you had any side effects from the surgery? Also, is it an inpatient surgery, if so how long are you in the hospital? How long do you have to be out of work? Sorry for all the questions  I'm trying to learn as much as I can before my appointment next week.


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## Lovlkn (Dec 20, 2009)

Christina,

Regardless of what your endo or doctor think if you an get an appt with a surgeon they will remove your thyorid because you have diagnosed thyroid issues. I asked my surgeon about insurance refusing to pay an she said it's never happened- if she decides it needs to come out then it comes out. Try to find a surgeon that removed 4-5 thyroids a week for experience level. Younger surgeons who trained at the Cleveland Clinic perform minimally invasive (1") incisions to remove.

My endo was more pro RAI and I refused and found a surgeon through a friend in the business (anesthesiologist) and had my appointment - my endo then offered the surgeon she would refer to but I was comfortable with the surgeon I met through my friend.

Proper replacement post op is key. Begin T-4 replacement within a few days post op. Insist they start you on 1.7mcg per kilogram of your weight and adjust from there. Most doctors try to start you on 100mcg which isn't enough for many people. Always test FT-4 and FT-3 when making dose adjustments. If after 3-6 months yourFT-3 is below mid range supplement with Cytomel.

Good luck. I got preggers with my second son with full blown graves the first try (I could only tell from my eyes) as I never received a DX until he was 5 but my moods and eyes told the story.


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## Linty (Aug 25, 2011)

Christina, I didnt have calcium issues because surgeon didnt hurt parathyroids in any way, but they did bloods 2x for calcium probs. I was 3hrs in surgery almost 2 days in icu and 2 days in general ward. Shouldhave been 1 day shorte but he was concerned because i wasnt feeling well and had some symptoms still from Graves. Iwas at home for week and then only after that worked half day (own business), you have to get alot of rest and drink fluids. Ask if you need more info, i will tell you about my experience. It was my 1st op and 1st time in hospital (blush) and i was a real pain in the ass. I was terrified before the op.

Good luck and hope you get answers soon. 
hugs2


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## webster2 (May 19, 2011)

Good afternoon,
I don't have much to say that is helpful. I did become pregnant about 3 months after my surgery. I found these links that might be of interest to you. Best of luck to you.

http://www.empoweryourhealth.org/pregnancy-and-thyroid#


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## christina20003 (Sep 27, 2011)

Thanks for all the advice ladies. It is very helpful. I'm glad to hear that some of you have been successful getting pregnant after surgery. Unfortunately for us, even with the surgery, we will most likely need fertility treatments to have a baby due my husbands sperm issues. I'm fairly confident that if it weren't for those issues, I would have been able to become pg even with the Graves' as I've had regular cycles all along. I need the thyroid issues resolved for fertility treatments, plus I want to feel better and be as healthy as possible for pregnancy.

From what I've been reading, whether having surgery or RAI, most people end up hypo and need life long replacement anyway. Why not just get it out and be done with it? I live in Maine and am wondering if I should look for a surgeon in the Boston area. I'm not sure what kind of selection there will be here, and Boston is only 3.5 hrs away and they have some of the best hospitals/doctors in the country. Any of you travel for the surgery?


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## webster2 (May 19, 2011)

One of our library patrons went to Boston, and was very successful...twice! I live 4 hours from Boston!


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## christina20003 (Sep 27, 2011)

webster2 said:


> One of our library patrons went to Boston, and was very successful...twice! I live 4 hours from Boston!


Are you talking about thyroid surgery or fertility treatments? If she had to go twice for surgery, I don't think I'd call that successful 

There's a branch of a Boston-based fertility center very close to my work. I plan on starting there with the fertility treatments after I kick this thyroid thing.


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