Underactive Thyroid and Prolactin Levels

Hi does anyone know why Hashimoto's thyroiditis may cause high levels of prolactin? I have symptoms of high levels and GP is going to be testing for this together with other relevant blood tests. I am concerned that I may have a problem with the pituitary gland and if this is the case could my TSH levels be inaccurate? At the minute my TSH levels are low but I still suffer from extreme tiredness despite the low readings! Can I insist on being referred to a specialist?

[BadHare]

How high?

Above 500 (parts of prolactin per whatever, sorry I can't remember what) indicates a prolactinoma, a pituitary tumour. If this is the case, it'll be confirmed by an MRI scan. You might be tested for other pituitary hormones & anomalies, too.

Useful information here: pituitary.org.uk/informatio...

There are local groups dotted around the country should you need help.

I found my GP ignorant, & my endocrinologists ignorant & utterly useless, as all ignore the symptoms list from The Pituitary Foundation & Thyroid UK in favour of blood test results which can be within normal range with secondary hypothyroidism. I've been self-medicating successfully for 5 years after 45 years of hypo symptoms.

[Hidden in reply to BadHare]

Thank you so much for your helpful reply. I know what you mean about the professionals being ignorant! Plus the state of the NHS at the minute we don’t stand a chance do we! I am pleased to hear that you have managed to self medicate successfully. I think this may be my only option to at some point!

[BadHare in reply to Hidden]

You're welcome!

I had hypo symptoms before the pituitary tumour symptoms started. Retrospectively, I can't believe I wasn't diagnosed in my teens.

I hope you're successful in getting help! If not, make sure your nutrient levels are good & get your own meds. Trust your body, & advice on this wonderful forum, not the medics!

[helvella Administrator Thyroid UK]

There are quite a number of papers and sources - this is one which tries to explain briefly in its abstract. But then leads onto a complicated case report:

Primary Hypothyroidism with Markedly High Prolactin

Mohd Saleem Ansari1,* and Mussa H. Almalki1,2

Abstract

Secondary pituitary enlargement due to primary hypothyroidism is not a common manifestation. The loss of thyroxin feedback inhibition in primary hypothyroidism causes overproduction of thyrotropin-releasing-hormone (TRH), which results in secondary pituitary enlargement. TRH has a weak stimulatory effect on the lactotroph cells of the pituitary, so a mild to moderate increase in prolactin (PRL) levels is expected. We report the case of a 67-year-old female who presented with a large pituitary mass and a very high level of TSH in association with a significant rise in PRL level. In this case, diagnosing a sellar mass was challenging; it was difficult to distinguish between pituitary prolactinoma and primary hypothyroidism with secondary pituitary hyperplasia. Thyroid hormone replacement proved that this patient’s hyperprolactinemia was due to hyperplasia of the pituitary gland. As such, making the correct diagnosis and initiating thyroid hormone therapy can prevent unnecessary treatment with dopamine agonists.

Keywords: pituitary, hyperplasia, hypothyroidism, prolactin, thyroid hormone

ncbi.nlm.nih.gov/pmc/articl...

[BadHare in reply to helvella]

Tak helvella , haven't seen that before!

[radd in reply to BadHare]

😂

[radd]

JewelsP

Elevated prolactin is usually associated with high TSH levels which can stimulate the pituitary in producing too much but in this & previous posts you state yours is low.

But your TSH results could be accurate because prolactin is controlled by dopamine which restrains the production of prolactin as oestrogen which increases it. The hypothalamus that secretes TRH to tell the pituitary to secrete TSH to encourage more thyroid hormone needs dopamine to function properly. Therefore, low dopamine levels would also result in lower TRH levels & lower TSH levels & elevated prolactin.

A common symtom of insufficient dopamine is extreme tiredness as is linked to the nervous system. Are all your B vits adequate ?

There is also a link between high prolactin levels & gluten.

Yes, you need a specialist because it is unlikely your doctor will know any of this.

[Hidden in reply to radd]

Thank you so much for your reply radd . What you say about the insufficient dopamine rings true. The GP thinks that keeping me on the higher dose of levothyroxine with the low TSH should help but I am still exhausted! In fact have always suffered with the tiredness despite medication!

[Hidden]

Jewels. The pituitary foundation can guide you to an endocrinologist. There are some pituitary centers of excellence in the country to which you can ask to be referred. and the also have a specialist nurse with whom you can talk over the phone. It is as others have said possibly a pituitary.

The commonest cause of insufficient dopamine is medication. Psychiatric drugs, especially antipsychotics although there are some anti Ds that can do the same. This can and does cause prolactin excess.

Our favorite but sadly now no longer with us, Dr Skinner wrote in his book about thyroid care that he came across lactation quite a lot in his thyroid clinics and that he thought the pituitary gland needed thyroid hormones to function fully as much as the thyroid gland needed pituitary hormones and that chronic low levels of thyroid hormone led to unresponsive TSH and various other pituitary hormone issues.

So a plan of action I would suggest is to talk to the pituitary foundation.Have a look at any medication you might be taking and check with pharmacist to see if that is a possibility and also post you latest blood results here for us to have a look and see if your thyroid care can be optimised. In us thyroidly patients then can be numerous causes for us feeling very tired and there might be more than one reason. So you need a bit of an MOT but unfortunately you are unlikely to get this via the GP. Your GP should have taken your TSH, T4 and ideally T3 ( but this is often refused). He should also have taken vitamin D, folate, ferretin and B12 and if you are very lucky antibodies. If these have not been done you might want to ask but speak to the pituitary nurse first as she might have some suggestions of what else might need to be included. Hope you feel better soon and keep posting here until you do. It can take a while.

[Hidden in reply to Hidden]

Thank you so much for your really helpful reply. I will know more once I get my bloods tested and if prolactin levels are unusually high which I suspect they may be I will contact the pituitary foundation.

[jgelliss]

Sometimes high prolactin levels can come from mothers that are breast feeding .

ncbi.nlm.nih.gov/pubmed/209...