New results - grateful for any input

[Jamima]

I received my thyroid, prolactin and progesterone results from medichecks today. Tested at 08.30, fasting, stopped b supps 1 week before, finger prick test. I asked for prolactin as I’d read somewhere that elevated levels could be an indicator of a pituitary problem and I’ve a suspicion this might be a problem for me. I also asked for progesterone as just over a year ago I had a low 24 hour cortisol result and I’ve been using progesterone to increase those levels. I’m feeling much better (got all vets & iron up to good levels) than I did a year ago but still have brain fuzz, painful joints and constipation, the crashing daily fatigue has mostly gone but eg a 2 hour dog walk will still leave me tired and fuzzy. Any help with these results would be very much appreciated.

19/3/21

TSH 1.63 (0.27 - 4.2)

FT3 3.82 (3.1 - 6.8)

FT4 13.30 (12 - 22)

Progesterone - 167.00 nmol/L - (post meno <0.401)

Prolactin - 419.00 (102 - 496)

GP blood cortisol 8.50am, fasting - 470

GP thyroid 27/11/20

TSH - 0.95 (0.2 - 4.5)

FT4 - 11 (9 - 21)

GP Thyroid 02/07/20

TSH - 1.7 (0.2 - 4.5)

FT4 - 12 (9-21)

The last full thyroid before this test was jun 2020 with medichecks

TSH 1.88 (0.27-4.2)

FT3 4.19 (3.1-6.8)

FT4 12.3 (12-22)

Antibodies ok.

[Jodypody]

That T3 is low are you on Levo or NDT?

[Jamima in reply to Jodypody]

Hi Jodypody - no I’m not on T3, just 10mg progesterone and daily vits. I’m going to make an appointment with a private endo I’d spoken to last year. He asked my GP to carry out an SST and some other adrenal tests but she refused so I’ve changed GP and have been referred to NHS endo who doesn’t think there’s anything wrong with my thyroid.

[Hashihouseman]

Even for a bloke the prolactin issue is tricky, maybe especially for males because it’s the tsh activity that appears to stimulate the pituitary into overdoing the prolactin, which I can well do without. Mine has been almost as high as yours, not good. I find that sage and broad beans help a bit ! But mine is always positively associated with TSH and like you I worried there was a pituitary issue so I had a brain scan and no, conclusion was it’s another thyroid complication. Now I use high end prolactin results to tell me if my tsh has been too high.

[Jamima in reply to Hashihouseman]

Thank you Hashihouseman - would you explain why it’s not good for prolactin to be high and how this affects thyroid. My endo is adamant I don’t have a thyroid problem.

[Hashihouseman in reply to Jamima]

Well it’s primarily for lactation and a few other things that are sex hormone related that men wouldn’t need it’s relationship with thyroid is that it’s a sign of ypothyroidism if it’s elevated and I guess that seen relationship goes for women too.

[Jamima in reply to Hashihouseman]

Thank you, so elevated levels definitely mean there’s a thyroid problem? I think I have central hypo which is pituitary based.

[Hashihouseman in reply to Jamima]

I wouldn’t say anything is for definite with thyroid and hormones generally because there so so much Inter individual variability. All I can say is that my prolactin definitely goes up with TSH and is only normal if my TSH is suppressed. I do not have central hypo or at least it’s never been diagnosed and there are no symptoms pointing at that. All my reading around it suggests that it’s simply overstimulation of the Pituitary because of hypothyroidism

[Jamima in reply to Hashihouseman]

Ok, thank you for the explanation.

[Jamima]

Thank you Scrumbler- the prolactin has concerned me. I’ve got a telephone consult with my nhs endo on 1 April, he seemed adamant that my thyroid was healthy, should I show him these results? He was scathing of my last private testing.

[Jamima]

Yes, I’ve got one who’s great that I’m going to contact for a 2nd time. Thanks again.

[Jamima]

Yes, he said that to me at last appointment so I thought it unwise to show him these results. He asked me to provide a 24 urine sample for cortisol so I’ll see what he says about that.

[Jamima]

I don’t think it’s there?

[Jamima]

I know all about that! Thank you.

[greygoose]

I don't know a lot about prolactin, but I do know that high levels can be caused by both under-active thyroid and a pituitary problem.

Your last test showed that your prolactin is within range, so that wouldn't appear to be any sort of a problem. But, you could still have a pituitary that isn't producing enough TSH to stimulate your thyroid to make normal, healthy levels of thyroid hormone - i.e. around 50 % of the range for both FT4 and FT3. Your FT4 is only 13.3% through the range, and FT3 19.46%. Both much too low, but your TSH doesn't reflect that.

The problem is that Central hypo is considered to be very rare. Doctors therefore never test for it - some have never even heard of it - and those that have often refuse to even consider it. That's what happens when something gets the label 'rare', although in reality it would not seem to be as rare as all that!

If your problem is Central Hypo, then the endo is right, there is nothing wrong with your thyroid. It's just not getting enough stimulation. And, your Frees are both still in range, so for the majority of doctors, that's good enough. And, they don't know enough about thyroid to take symptoms into consideration. So, it's an uphill battle, I'm afraid.

Low cortisol is another indicator of pituitary problems. But, you would have appeared to have destroyed the evidence on that one. So, all I can suggest - unless anyone can come up with the name of an endo that actually knows something about hormones other than insuline - is that you wait until things get worse, until the Frees actually go under-range. Daunting prospect, I know. But I can't see any other way around it, with endocrinology in the state it's in right now: doctors knowing nothing but thinking they know it all!

[Jamima]

Thank you greygoose, I’d spoken with a very good private endo who specialises in pituitary last year and will contact him again.

[Bearo in reply to Jamima]

If your private endo does consultations at a distance I would be grateful for contact details.

[Jamima in reply to Bearo]

No problem, I’ve sent you a pm.