Prolactin

Medical Q&A [Moderated]
1

Hello doc,

(Male 28yo, 170cm 76 kg)I have hypothyroidism and being treated with supplemental T4 for 5 years now. I have present antibodies but not out of limit, and it was diagnosed because I was feeling weak, like weak (no major strength loss though) not fatigued and results came back with elevated TSH near 10 and T4 in the low end limit. Since my diagnose 5 years ago, my endocrinologist orders a panel of hormones to check annually (like test,prolactin cortisol etc). The first three years everything was normal besides TSH which would fluctuate sometimes good sometimes bad you know nothing special. My prolactin was 12-16 (sry I do not remember the metric but the upper limit I think it is 22) . On the summer of 2021 i did the same exams TSH came back 5 (I upped the dose) and prolactin was 28. I was during a really high stress period of my life with no sleep etc and doc said it is due to stress and my test was fine.On December 2021 i retested for the TSH and it was 1.2 with the new dose. Now here is the deal, on July 2022 I did the same panel of hormones TSH came back 9, prolactin 38 and T4 in the middle of the spectrum. I would like to add that I gained 10 kg of bodyweight, from 70kg to 80kg, with a dirty bulk (but waist within limit). During that period i was working out like crazy, upping volume. Moreover I had stress because I am doing a Msc and I had exams.Also I did not sleep the night before and got my blood work 30 minutes after I have woken up like 8 in the morning, my regular sleeping schedule was 3-4 in the morning with 11 to 12 in the morning again (sleeping really late).So for my case the blood draw was in the middle of the “night”. My endocrinologist saw the results and said that the increase in TSH maybe it was due to the extra bodyweight and he attributed prolactin again in stress and when I asked why do we measure all this hormones he said that if it is stressing me out we could never measure it again. Since then, my strength have increased and I dropped a lot of bodyfat, I now stand at 75-76 kg. I am worried about a prolactinoma doc, like really worried. I am trying to calm myself arguing that if i had a secreting tumor during that period my test would have dropped and i would have made no strength gains etc. I do not know, I am thinking of pushing for an MRI but then again I am thinking what if they find something incidental and I’ll be nociboed to hell. Do you think that I should retest prolactin? Any advice will be appreciated.

2

Hi there,

This is clearly a complex situation and I can understand the concerns. Unfortunately we can’t feasibly recommend for or against an individual getting a particular test done via this forum. It sounds like you are aware of the general pro/con considerations at play here, for example regarding the MRI. I would recommend continued discussions with your endocrinologist regarding whether repeat/ongoing blood tests would be helpful (given the circadian issues you describe), versus whether the imaging would be recommended. Repeating the labs would be the simplest next step though.

3

Thank you, I would like to add that the first year of my hypo diagnosis, I got an mri of an unrelated issue (tinnitus) in which the pituitary gland was normal. That is 2-3 year before the first prolactin raise tho. What is your opinion in the proposal that we should not measure it again

4

I understand that there is no answer to my previous question from a forum. It seems to me that I did everything to get a raised prolactin result. I was underdosed for hypo, full on training even with double train sections in one day for lifting and cardio the previous 4 days. Previous day I did a prolonged afternoon work out (I’ve found some literature that prolactin rises with exercises and recovery and whatever), did not sleep well, and had a lot of stress too because even before my result I was anxious about it. I’ll think about it