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What causes elevated prolactin levels?

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Practicing since : 2001
Answered : 1663 Questions
I have been having issues wirh elevated prolactin for over 7 years since i gave birth. When i gave birth i had postpartum thyroiditis and went from hyperthyroid to hypo. Ive never been treated for the thyroid. I have tried dopamine agonists for the prolactin but am intolerant to them. I saw an endocrinologist yesterday who believes my thyroid could be causing the prolactin problem since i have had many clear MRI of the brain and pituitary. My prolactin is 108, my TSH is 0.9 and my free T4 is 0.7. I do have symptoms of hypothyroid including weight gain, cold intolerance and severe fatigue. He prescribed me orthotricyclen for my cycle since i havent had a period in a year and 50mcg levothyroxine. Do you agree with this treatment ? Do you feel the thyroid could be causing my elevated prolactin? Thanks
Posted Tue, 11 Mar 2014 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 6 hours later
Brief Answer: Thyroid and Prolactin Detailed Answer: Thyroid and prolactin problems, like many facets of endocrinology can be complex at times. Sometimes it is straightforward for the formally trained endocrinologist, but occasionally one comes across instances where the picture is not clear cut from the outset but may evolve into a more definitive diagnosis over time. In your case too, I see persistently elevated prolactin with seemingly normal thyroid function tests. Are you on any other medications aside from orthotricyclen, such as psychotropic medications. I ask this because there are scores of medications that can raise the prolactin. In fact, even orthotricyclen can do so as it contains estrogen. Do you have milky discharge from your breasts? Do you have a neck swelling from thyroid enlargement? When I see someone like you, I typically order the following tests at sharp AM in the morning : (there is no need to fast) 1 CBC 2 CMP 3 Serum Cortisol 4 IGF! 5 Prolactin 6 TSH 7 Free T4 8 Total T4 9 Total T3 10 T3 resin uptake 11 FSH 12 LH 13 Beta hCG qualitative It would be nice if you can run these before you start orthotricyclen and levo thyroxine
Above answer was peer-reviewed by
Follow-up: What causes elevated prolactin levels? 4 minutes later
I am on no medications and have not started the orthotricyclen or synthroid yet because im questioning if this is the correct route. I had my AM cortisol drawn and it was 11. Cbc was all within normal limits. Estradiol is 20. Prolactin 108. TSH 0.96. Free T4 0.72. LH 7.4. FSH 4.7.... Multiple MRI studies with contrast are all. NORMAL including a recent MRI from last month. I will not take dopamine agonists again. What is my other options ? Is it simply take birth control ? If so which one is best ? Please help
Answered by Dr. Shehzad Topiwala 4 hours later
Brief Answer: Follow up Detailed Answer: I would still like to know the IGF1 and beta hCG and CMP Dopamine agonists are the only medications known to be effective in 'curing' high prolactin levels. Bromocryptine is known to cause stomach problems amongst other things but Cabergoline is better tolerated. Have you tried the latter? It seems the only problem you have from the high prolactin is lack of periods. Taking birth control will fix that symptom but the fact that your reproductive axis is affected implies that it is quite likely you will difficulty getting pregnant. Are you planning to get pregnant? This consideration is important
Above answer was peer-reviewed by
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