On Thu, 26 Aug 1999 Judy Gutowsky wrote:
> In my private practice I have a client diagnosed with Grave's disease.
> MD wants to take immediate action requiring a 2 week temporary weaning due to
> radiopharmaceuticals.
Judy: It's not clear to me what the radiopharmaceuticals are being used
for. Is it for a thyroid uptake scan for diagnosis, or is it radioactive
iodine treatment. If it's the former, it may be possible to find an
isotope with a shorter half-life, so that she doesn't have to interrupt
breastfeeding quite as long. If it's the latter, my understanding is that
breastfeeding would be permanently contraindicated after that procedure.
If Graves' needs to be treated in a mother who hopes to breastfeed, the
preferable options are PTU suppression or surgery. How old is the baby?
> 1. Is it possible to use the milk mom pumps after allowing it to
> decontaminate for a period of time and be tested with a Geiger counter?
Yes, I believe that once 5 1/2-lives are gone, there is very little
radioactivity left.
> 2. How would the milk be stored for this to happen?
I imagine it would need to be frozen. I doubt that the radioactivity
would be sufficient to contaminate nearby foods, but I don't really know.
> 3. Where can we get milk tested for radioactivity?
Sorry, I don't know, but I imagine the nuclear medicine department where
the scan is done would know.
> 4. Is there any possible contamination of the rental breast pump?
Again, I'm no expert on this, but I believe the radioactivity in the milk
would be very small, so any traces on the pump which would then be
routinely washed away anyway, should not be of concern.
> 5. In your collective experience, what is the likelihood of a 5 1/2 month
> infant returning to breast after a two week weaning and physical separation
> from mother?
This could be tough, but I've read about both failures and successes after
moms have left for vacations or business trips.
> 6. What options have other mothers taken to avoid this situation?
PTU or surgery.
> 7. As her LC who is 34 weeks pregnant what precautions do I need to take
> in having physical contact with her during the treatment time?
I believe the risk to you is minimal. It's only her baby, who would be
in very frequent close contact with her, who might theoretically be at
risk. Still, it may be worthwhile checking with the nuclear medicine
department, especially in view of your pregnancy.
> The MD insists this treatment is urgent or mom will suffer heart damage,
> not even allowing time for a second opinion.
It is the mother's choice whether she gets a second opinion or not. It's
not for the doctor to give permission. If the mother is having a
rapid heart rate or an arrhythmia, that can usually be controlled with
beta-blockers (compatible with breastfeeding). If these have been tried
and her symptoms are no better, then she does need something done urgently
but that can't rule out a second opinion unless she is actively going into
heart failure or had a heart attack already.
Mom is willing to have a
> thyroidectomy as opposed to the radioactive treatment so baby's weaning will
> not be involved, but MD says it isn't done anymore.
This is just not true. Of course, radioiodine ablation is generally
preferable to surgery for most people, but that does not mean that the
surgery is not an option. If she chooses to have the surgery, she needs
to see a good head and neck surgeon experienced in this procedure.
However, she could avoid surgery by trying PTU. Has this been tried?
There are a number of
> family members who have this same problem and have had various treatments.
> Is there a hereditary predisopsiton to this disease?
Yes. Autoimmune thyroid conditions do run in families.
Hope this helps. Regards, Alicia Dermer, MD, IBCLC.
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