I have permission from my patient to post.  She is a 31 year old who has a 3
year old son and a 4 day old baby.  Nine months ago she was diagnosed with
thyroid cancer.  Four days later she found out she was pregnant.  She had
surgery during her pregnancy to remove her thyroid gland and she's on
thyroid replacement medication.

She called me today because I helped her to successfully breastfeed her
first baby (She nursed for 14 months) and she had the following issues:

1. Her nipples are sore and she's not sure if her "milk is in" yet.  She
does not have the same feelings of fullness on day 4 that she remembers
having with her first baby.

2. She will need to have a radioactive iodine treatment (she thinks they
will use I-131) somewhere between 6-12 weeks from now.  She will be going in
for an examination in 3 weeks and that will determine how soon she needs the
iodine treatment.

My big question is: At what point should she discontinue breastfeeding?  It
is clear to me that breastfeeding is contraindicated with I-131, and should
be discontinued sometime before the treatment to allow for complete breast
involution.  How far in advance?

My additional question is: Depending on the answer to my first question,
should I even encourage her to start breastfeeding?  I am planning to see
her today or tomorrow to assess her latch as well as her milk supply.  I
wonder if she indeed has a milk supply issue, is it related to:
1. her thyroid removal
2. her baby's latch
3. her health status (she is not feeling sick) and stress and exhaustion
4. all of the above

Of course she is feeling guilty that her body has let her and her baby down.
She is proud of having given her first baby 14 months of breastmilk, and she
is feeling horrible about having to use formula for this baby.  I
recommended the milk bank, but she is having financial difficulties due to
her health needs.  I suggested she call the milk bank anyway and see if they
can work with her.

Please respond ASAP so I can give her the best guidance.  Thanks.


============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
Telephone: (818) 345-4439
Cell Phone:  (818) 929-7584
E-mail: [log in to unmask]




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