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What is the cause and treatment for elevated prolactin level?

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Practicing since : 2001
Answered : 1663 Questions
I just got diagnosed with hashimotos. TPO was 322. I have been battling with elevated prolactin for years last level was 120. My tsh is 0.6 and free t4 is 0.7. What dose of synthroid would u start me on? How long before i start to feel better and my prolactin levels come down. Multiple MRI's are clear so endo say prolactin is from thyroid. Just wanting a second opinion. Thanks.
Posted Mon, 17 Mar 2014 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 3 hours later
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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Follow-up: What is the cause and treatment for elevated prolactin level? 8 hours later
Cbc and cmp were all normal. I only have free T4 which has been 0.78 both times it was drawn. My AM cortisol was 11.7 on one test and a month later it was 19. My TSH has fluctuated between 0.6 and0.98 this month.
Answered by Dr. Shehzad Topiwala 22 hours later
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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