Brief Answer: Prolactin Detailed Answer: The picture is a bit unusual here. When a given individual has positive TPO it is likely they have Hashimotos which typically results in an under active thyroid. This manifests as a low or normal T4 with higher than normal TSH. Your TSH is also on the low normal side. So it does not fit the classic picture of a severely under actice thyroid that causes a significantly elevated TRH and TSH, of which the the TRH from the hypothalamus promotes a rise in the prolactin. In this well described circumstance, treating the underactive with thyroxine, and normalizing free T4 and TSH often lowers the prolactin back into normal range. In your situation, this explanation cannot be applied. You need a thorough work up for your prolacitn as well. I have noted the normal MRIs. It is good that apparently there is no tumor. Are you on any medications? Are your menstrual cycles normal? Have you had labs for CBC CMP Total T4 Total T3 T3 resin uptake beta hCG I would even consider an 8 am serum cortisol level along with IGF1 This requires a systematic evaluation by an endocrinologist. I understand you are seeing one but perhaps a second opinion for an in person assessment wont hurt

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Brief Answer: Follow up Detailed Answer: The AM cortisol seems all right. I have noted the TSH fluctuations but they dont appear significantly different based on endocrine standards. I still encourage the other tests beta hCG and IGF1 along with Total T4 , Total T3 and T3 resin uptake tests because the free T4 and T3 can be misleading at times.

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