June 13, 2012

Thyroid ablation, a postpartum update, and never before seen photos

In 2007 I underwent thyroid ablation with radioactive iodine. I was 24 at the time and the process of coming to the decision to have the procedure had filled the many preceding months with anxiety and turmoil.

A radioactive isotope. Intentionally (yet strategically) destroying a part of my body. A 6-12 month wait required before trying to conceive. The possible side effects. The permanence of my decision. It was a lot to weigh at such an inexperienced and young age.

As it turns out, the procedure was a simple one. My thyroid was scanned to determine the correct dose. A tech arrived with the formidable lead container. I swallowed a capsule of radioactive iodine, chased it with some apple juice and spent the following week in my pajamas, housebound to minimize other people's exposure to my radioactivity.

(circ. 2007)
 I received a handout with instructions similar to those listed below, and hunkered down.

Instructions to reduce exposure to others after I-131 RAI treatment
ActionDuration (Days)
Sleep in a separate bed (~6 feet of separation) from another adult .......................................1-11*
Delay return to work ................................................................................................................1-5*
Maximize distance from children and pregnant women (6 feet)................................................1-5*
Limit time in public places .........................................................................................................1-3*
Do not travel by airplane or public transportation ...................................................................1-3*
Do not travel on a prolonged automobile trip with others .......................................................2-3
Maintain prudent distances from others (~6 feet) ...................................................................2-3
Drink plenty of fluids ................................................................................................................2-3
Do not prepare food for others ................................................................................................2-3
Do not share utensils with others ............................................................................................2-3
Sit to urinate and flush the toilet 2-3 times after use ..............................................................2-3
Sleep in a separate bed (~6 feet of separation) from pregnant partner, child or infant ..........6-23*
*duration depends on dose of I-131 given

Stimulated by a hormone called TSH, the thyroid gland regulates metabolism and uses iodine to make thyroid hormones (T4 and T3). It is the only organ in the body that uses iodine and so the radioactive isotope goes straight to the thyroid where it is absorbed.  The tissue of my thyroid died over the course of a few months, my hyperthyroidism (low tsh, high t4 and t3) became hypothyroidism (high tsh, low t4 and t3), and I began what is a lifetime dependency on synthetic t3 and t4.

I take a small pill of levothyroxine every morning and the drugs regulate my body like a healthy thyroid gland would. My TSH levels were in the normal range when I got pregnant with each of the boys, but pregnancy involves a higher demand for these hormones because they are also responsible for the growth of the fetus and for building the baby's thyroid gland. During pregnancy I get blood tests every 3 weeks so that my dosages can be closely monitored and increased as needed. Usually, by week 12 or 16, my doctor has found the dose that I will need for the remainder of the pregnancy and I stay there until the baby is born.

In the postpartum period, it is the reverse, a slow ramping down of the levothryroxine dose in order to return to a normal baseline. It has been 16 months since Merritt was born and I am STILL incrementally decreasing my doses.  In fact, 2 months ago, I was feeling off and asked for a test to confirm my suspicion. The results showed that I was hyperthyroid again--too much levothyroxine. My prescription was decreased from 112mg to 100mg but just 6 weeks later I was feeling lethargic and out of it (and requested another blood draw) only to learn that my TSH was lower than it had ever been in my entire medical history.  Over the weekend it was confirmed to be 19, on a normal scale of .3 -3!

With the help of my former docs at Georgetown hospital in DC, I was able to secure a semi-emergency appointment for tomorrow morning with a new endocrinologist at the local academic medical center to get some answers and hopefully to get my hormones back on track asap. I cannot tell you how challenging it is to manage day to day when my levels are off.  All the little things required of me are downright exhausting and I want nothing more but to crawl into bed. Clearly not a viable option, with a 3 year old and a 1 year old underfoot.

It has been almost four weeks of this and I am happy to learn that my thyroid is the culprit, so that I can do something about it, but I have also been feeling a little desperate for a resolution. Thank goodness for our nanny (who is back with us a few blocks of time each week), and good friends who bring dinner to our doorstep.

3 comments:

  1. Wow! Thyroids are so darn complex. My SIL went through a tough year and a lot of it was related to her thyroid being out of wack (she is also on meds for life).

    I used to work with I-131 and other radioactive isotopes in my lab days. My old-school boss was so lacksadaisical about it - even dumping it down the sink (!!!!!) I shudder to think of what exposure I could have given myself if I'd stayed there. Yikes!

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  2. Pretty crazy stuff. I hope you are able to get everything on track and leveled out quickly. My sister-in-law struggles with her thyroid, especially when she is postpartum, and it messes with her body and mind so badly. She can't seem to get her dosage correct for any long period of time these days either after having her second child 2 years ago!

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  3. Thanks for sharing! I found this helpful since I will be undergoing the same treatment soon. It was helpful to read about someone elses experience.

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