Basal and TRH stimulated serum levels of TSH in patients with hyperprolactinaemia and in subjects on oestrogen treatment
Abstract. In 21 hyperprolactinaemic patients without other signs of pituitary dysfunction the mean basal serum level of TSH was 4.4 ± 0.47 μU/ml that was significantly (P < 0.001) higher than controls (2.5 ± 0.16 μU/ml and oestrogen treated individuals (2.4 ± 0.29 μU/ml). The TSH increase was more pronounced (P < 0.05) in hyperprolactinaemic patients without sellar enlargement and with moderately elevated plasma prolactin levels (155 ± 42 μg/ml) than in patients with sellar enlargement and higher plasma prolactin levels (857 ± 306 μg/ml). The serum levels of thyroxine and triiodothyronine in the hyperprolactinaemic patients did not differ significantly from controls. Patients with thyroid antibodies were excluded. The increased basal serum level of TSH in hyperprolactinaemia is compatible with the concept of a reduced dopaminergic tonus as the mechanism for both changes. In patients with advanced hyperprolactinaemia and sellar enlargement the high prolactin level may induce some inhibition of TSH release and explain their lower basal serum level of TSH that was probably not due to pituitary compression as they responded normally to TRH. The TSH response to TRH was significantly (P < 0.05) correlated to the basal serum TSH in all groups. The regression lines were very similar for hyperprolactinaemic patients and controls suggesting that in hyperprolactinaemia the thyrotroph has not changed its mode of response to TRH. In contrast, oestrogen treated subjects in addition to dependence on basal serum TSH levels showed a genuinely augmented response to TRH (164.6 ± 20.3%, P < 0.01) compared to controls.