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Dr. Eric Daiter

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Dr Eric Daiter has served Monmouth and Middlesex Counties of New Jersey as an infertility expert for the past 20 years. Dr. Daiter is happy to offer second opinions (at the office or over the telephone) or new patient appointments. It is easy, just call us at 908 226 0250 to set up an appointment (leave a message with your name and number if we are unable to get to the phone and someone will call you back).


"I always try to be available for my patients since I do understand the pain and frustration associated with fertility problems or endometriosis."


"I understand that the economy is very tough and insurance companies do not cover a lot of the services that might help you. I always try to minimize your out of pocket cost while encouraging the most successful and effective treatments available."

NJ Center for Fertility and Reproductive Medicine - Infertility Tutorials

Treating Ovulatory Dysfunction: Hyperthyroidism
Treatment of hyperthyroidism has many objectives, including

* (1) Inhibiting the synthesis and secretion of thyroid hormone by the thyroid gland

* (2) Blocking beta adrenergic receptors to limit the clinical manifestations (symptoms) of hyperthyroidism

* (3) Treating associated medical problems that can either exacerbate hyperthyroidism or can be exacerbated by hyperthyroidism

The initial objective of treatment is to inhibit thyroid hormone synthesis and secretion while controlling beta adrenergic stimulation (if excessive). The two primary medications used to limit thyroid hormone production are methimazole and propylthiouracil (PTU).

Methimazole inhibits organification of iodide (to iodine) to decrease the thyroid gland's synthesis of T4 and T3 (the active thyroid hormone). This medication is taken by mouth and you initially see an effect in 2-4 weeks. T4 has a long half life in the circulation (about 1 week) and there is a large store of T4 within the thyroid gland so decreasing the circulating T4 concentration takes a relatively long time. Repeat blood studies are usually performed 4-8 weeks after changing a dose to allow maximal effect of the medication. The major side effects of methimazole are rash, gastrointestinal upset and very rarely granulocytopenia (a decrease in the total number of a type of white blood cell called granulocytes in the blood).

PTU inhibits the incorporation of iodine into thyroid hormone and also inhibits the peripheral conversion of T4 to the more active form T3 (methimazole does not have this ability). Therefore, PTU is usually used when rapid reduction of thyroid function is desired. Side effects are uncommon (reported in <1%) and include rash, itch, GI upset. Very rarely, there may be a life threatening problem with reduction in blood cells (agranulocytosis) or platelet cells (thrombocytopenia).

Medication to control the beta adrenergic stimulation associated with hyperthyroidism includes a family of "beta blockers", including propanolol. The beta blocking agents rapidly control the beta adrenergic manifestations which include tachycardia (fast heart rate), palpitations (pounding of the heart), high blood pressure, cardiac arrhythmias (such as atrial fibrillation), constriction of the lung (especially during asthma attacks), migraine headaches (exact mechanism is unclear) and tremor. Propanolol competitively blocks the beta adrenergic receptors in the heart muscle (myocardium), the lung (bronchial smooth muscle) and blood vessels (vascular smooth muscle). Propanolol is given orally (or IV if necessary), and the dosage depends on the exact reason for administration.

Once the patient has returned to the euthyroid (normal) state a decision is made about long term treatment. If pregnancy is immediately desired, then continuing on PTU is usually advised because it is as effective as methimazole and does not cross the placenta as readily. If pregnancy is not immediately desired, then many women will decide to undergo "definitive therapy" involving radioactive iodine. The radioactive iodine is selectively taken up by the thyroid gland and is designed to destroy the bulk of the thyroid gland. Most of these patients eventually become hypothyroid and require lifelong thyroid hormone replacement. It must be determined with certainty that the patient is not pregnant prior to administering the radioactive dose since the medication will cross the placenta and can be taken up by the fetal thyroid. Pregnancy is usually delayed for at least 6 months after radioactive iodine treatment.

Hyperthyroidism in pregnancy should be treated, usually with PTU, to maintain thyroid hormone concentrations in the upper level normal to mild level hyperthyroidism region (to minimize fetal effects of PTU since some does cross the placenta).

Many women with hyperthyroidism have an elevation in TSH like autoantibodies. If these maternal TSH like autoantibodies cross the placenta during pregnancy they may precipitate fetal thyrotoxicosis which may result in a stillborn. PTU given to the pregnant woman also helps treat fetal thyrotoxicosis. Untreated hyperthyroidism in pregnancy is associated with preeclampsia, intrauterine growth retardation, and fetal heart failure. Monitoring of thyroid function should continue throughout pregnancy, similar to the recommended regimen for hypothyroidism.


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Eric Daiter, M.D. - Edison, NJ - E-Mail: - Phone: (908)226-0250

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