To      : Carolyn Zara
Re      : Graves Disease

The decision to ablate the thyroid is a tricky decision that requires an
experienced endocrinologist.

However, several options are available but must be evaluated for their
usefulness by the clinician at hand.   Propylthiouracil (PTU) has been used in
thousands of breastfeeding women and is known to be quite safe.  Just
ocassionally evaluate the infants' thyroid status if you are uneasy about the
medication.

Do not use methimazole.

If radioactive I-131 is used,  the breastfeeding mother should discontinue
breastfeeding for 7-14 days prior to exposure for two reasons.  First I-131
concentrates in breastmilk and can increase the infants risk of future thyroid
cancer and maybe even damage the infants thyroid.  In addition, approximately
28% of the radioactive iodine dose administered to the mother will concentrate
in the lactating breast tissue,  and may theoretically increase the risk of
breast cancer.

But we all know that thyroid function sometimes go ary during and after
pregnancy.  Its seems reasonable to wait and try other therapy before
destroying the thyroid completely.  But this still depends on the clinical
situation at hand.


Tom Hale