TSH-LH-FSH-PRL

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TSH-LH-FSH-PRL Comprehensive Test Guide

Section 1: Why is it done?
- Test Purpose: This comprehensive hormone panel measures four key pituitary and endocrine hormones: TSH (Thyroid Stimulating Hormone), LH (Luteinizing Hormone), FSH (Follicle Stimulating Hormone), and PRL (Prolactin). These hormones regulate metabolism, reproductive function, and lactation.
- Primary Indications: Evaluation of thyroid disorders, infertility assessment, irregular menstrual cycles, sexual dysfunction, pituitary gland dysfunction, hormone replacement therapy monitoring, lactation disorders, and menopausal symptoms
- Common Clinical Scenarios: Suspected hypothyroidism or hyperthyroidism, female infertility workup, male infertility evaluation, amenorrhea or oligomenorrhea investigation, galactorrhea evaluation, erectile dysfunction assessment, suspected pituitary tumors or pituitary insufficiency, and baseline screening during hormone replacement therapy initiation
- Typical Timing: Blood draw typically performed in early morning (7-10 AM) for optimal hormone measurement, ideally during follicular phase (days 3-5 of menstrual cycle) for women to ensure consistent results
Section 2: Normal Range
- TSH (Thyroid Stimulating Hormone): 0.4 - 4.0 mIU/L (milli-International Units per Liter) | Normal indicates proper thyroid function; elevated TSH suggests primary hypothyroidism; low TSH suggests hyperthyroidism or secondary hypothyroidism
- LH (Luteinizing Hormone): Women (follicular): 1.7 - 8.6 mIU/mL | Women (ovulation): 21.9 - 56.6 mIU/mL | Women (luteal): 0.6 - 16.3 mIU/mL | Men: 1.7 - 8.6 mIU/mL | Postmenopausal women: 14.2 - 52.3 mIU/mL | Elevated LH indicates ovulation surge or reproductive gland dysfunction; low LH suggests pituitary or hypothalamic dysfunction
- FSH (Follicle Stimulating Hormone): Women (follicular): 3.5 - 12.5 mIU/mL | Women (ovulation): 4.7 - 21.5 mIU/mL | Women (luteal): 1.7 - 7.7 mIU/mL | Men: 1.4 - 18.1 mIU/mL | Postmenopausal women: 25.8 - 134.8 mIU/mL | Elevated FSH indicates ovarian failure or menopause; low FSH suggests pituitary or hypothalamic dysfunction
- PRL (Prolactin): Women: 2.5 - 29.0 ng/mL (or 0.05 - 0.61 nmol/L) | Men: 2.5 - 17.0 ng/mL (or 0.05 - 0.36 nmol/L) | Elevated prolactin indicates hyperprolactinemia (pituitary adenoma, hypothyroidism, medications); low prolactin is rare and typically clinically insignificant
- Interpretation Guide: Results within normal range indicate normal endocrine and reproductive function. Values significantly above or below normal ranges require clinical correlation and may indicate underlying pathology requiring further investigation
Section 3: Interpretation
- TSH Interpretation: Elevated TSH (>4.0) indicates primary hypothyroidism where thyroid fails to produce adequate hormones, requiring thyroid replacement therapy. Low TSH (<0.4) suggests hyperthyroidism (overactive thyroid), central hypothyroidism, or suppressive therapy. Very low TSH may indicate risk of atrial fibrillation
- LH/FSH Interpretation Pattern Analysis: High LH and FSH with low estrogen suggests ovarian failure (menopause or premature ovarian insufficiency). High LH/FSH ratio may indicate PCOS (Polycystic Ovary Syndrome). Low LH and FSH suggest pituitary or hypothalamic dysfunction. Normal cycling pattern confirms normal ovulation
- Prolactin Interpretation: Mildly elevated (30-100 ng/mL) requires medication review (dopamine antagonists, antipsychotics); moderately elevated (100-300 ng/mL) suggests macroprolactinemia or stress; markedly elevated (>200 ng/mL) indicates probable prolactin-secreting pituitary adenoma requiring MRI
- Factors Affecting Results: Stress, sleep deprivation, exercise, menstrual cycle phase, pregnancy, lactation, medications (oral contraceptives, antipsychotics, antidepressants), pituitary stalk compression, hypothyroidism, kidney disease, and chest wall irritation all affect hormone levels
- Clinical Significance Patterns: Combined abnormalities are more diagnostically significant than isolated findings. Persistent abnormalities warrant repeat testing and imaging. Progressive trends over time may indicate advancing disease process requiring intervention
Section 4: Associated Organs
- Primary Organ Systems Involved: Anterior pituitary gland (produces TSH, LH, FSH, PRL), hypothalamus (regulates pituitary via releasing hormones), thyroid gland (responds to TSH), ovaries/testes (respond to LH/FSH), breast tissue (responds to prolactin), and adrenal glands (interact with reproductive hormones)
- TSH-Related Conditions: Hashimoto's thyroiditis, Graves' disease, thyroid cancer, thyroiditis, central hypothyroidism, pituitary adenomas, and TSH-secreting tumors
- LH/FSH-Related Conditions: Polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI), premature menopause, hypogonadism, infertility, Klinefelter syndrome, Turner syndrome, gonadal dysgenesis, pituitary hypogonadism, and hypothalamic amenorrhea
- PRL-Related Conditions: Prolactinoma (prolactin-secreting pituitary adenoma), pituitary stalk compression, hypothyroidism, chronic kidney disease, polycystic ovary syndrome, chest wall irritation/herpes zoster, galactorrhea, amenorrhea, sexual dysfunction, and infertility
- Potential Complications of Abnormal Results: Infertility, metabolic dysfunction, osteoporosis from hypogonadism, cardiac arrhythmias from thyroid disease, visual field defects from pituitary tumors, hypothyroidism-related complications (elevated cholesterol, weight gain, fatigue), and reproductive disorders
- Associated Pituitary Disorders: Pituitary adenomas, pituitary apoplexy, empty sella syndrome, lymphocytic hypophysitis, sarcoidosis affecting pituitary, hemochromatosis, and traumatic brain injury affecting pituitary function
Section 5: Follow-up Tests
- TSH Abnormality Follow-up Tests: Free T4 and Free T3 (assess thyroid hormone levels directly), anti-TPO and anti-thyroglobulin antibodies (assess for autoimmune thyroiditis), thyroid ultrasound (visualize thyroid structure), pituitary MRI (if central hypothyroidism suspected), TSI antibody (if Graves' disease suspected)
- LH/FSH Abnormality Follow-up Tests: Estradiol and progesterone levels (assess ovarian function), testosterone (especially in women to screen for PCOS/androgen excess), pelvic ultrasound (assess ovarian morphology), pituitary MRI (if pituitary dysfunction suspected), GnRH stimulation test (assess pituitary-gonadal axis), semen analysis (in male infertility workup)
- Prolactin Abnormality Follow-up Tests: Repeat prolactin level (confirm elevation, assess for macroprolactinemia), pituitary MRI with contrast (evaluate for adenoma or stalk compression), TSH and free T4 (hypothyroidism may elevate prolactin), pregnancy test (pregnancy elevates prolactin), medication review, visual field testing (if pituitary mass present)
- Comprehensive Pituitary Assessment Tests: ACTH and cortisol (assess adrenal function), growth hormone and IGF-1 (assess growth axis), sodium level (assess for SIADH if pituitary dysfunction present), pituitary MRI (gold standard for structural assessment), dynamic pituitary testing if central insufficiency suspected
- Monitoring Frequency: For thyroid disease: recheck TSH 6-8 weeks after treatment initiation, then annually if stable. For fertility workup: may need serial measurements or repeat during different cycle phases. For prolactinoma: recheck prolactin 2-4 weeks after medication adjustment. For pituitary adenoma: follow per endocrinology recommendations (typically every 3-6 months initially, then annually)
- Specialized Testing: Stimulation tests (GnRH, CRH, insulin tolerance test) to assess pituitary reserve, suppression tests (dexamethasone suppression) if Cushing's syndrome suspected, TRH stimulation (rarely used now), and karyotype analysis if chromosomal abnormality suspected
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is NOT required for this hormone panel. TSH, LH, FSH, and prolactin levels are not significantly affected by recent food intake, so patients can eat and drink normally before the test
- Optimal Timing: Blood draw should be performed in early morning between 7-10 AM when hormone levels are most stable. For women of reproductive age, ideal timing is 3-5 days after menstrual period starts (follicular phase) to ensure reproducible hormonal patterns
- Medications to Avoid or Report: Inform phlebotomist and ordering physician about: oral contraceptives, hormone replacement therapy (HRT), dopamine agonists (bromocriptine, cabergoline), antipsychotics (risperidone, haloperidol), antidepressants (SSRIs), metoclopramide, domperidone, verapamil, and antiemetics - these can affect hormone levels. Continue taking these medications unless specifically instructed otherwise by physician
- Pre-Test Patient Preparation: Avoid excessive stress 24 hours before test (stress elevates prolactin and FSH). Get adequate sleep night before (at least 7 hours). Avoid vigorous exercise on day of test. Limit caffeine intake on morning of draw. Stay well-hydrated. Avoid breast stimulation or chest manipulation 24 hours before test (can elevate prolactin). Wear loose-fitting clothing for comfortable blood draw
- Special Considerations for Women: LH and FSH levels fluctuate throughout menstrual cycle; testing on day 3-5 of cycle provides baseline follicular phase values for comparison. If irregular cycles, may need multiple tests across cycle. Pregnancy should be ruled out before testing. Note last menstrual period date. If on cycle-suppressing medications, discuss timing with physician
- Special Considerations for Men: No special timing requirements based on day/cycle for men. Morning blood draw still preferred. Avoid recent ejaculation (within 48 hours ideally) if fertility assessment is primary goal. Avoid anabolic steroids and testosterone supplementation unless prescribed and coordinated with test
- No Additional Restrictions: No need to avoid alcohol, skip meals, or restrict fluids. No contrast agents or special preparations required. Standard venipuncture procedure with serum separator tube typically used. Results usually available within 1-2 business days

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