Breast Fullness in a Hypothyroid Patient

Q: I am now 27 years old. My son is 4.5 years now. I had a normal delivery and I fed him for 1 year. I didn’t take any pills to control milk; it gradually reduced. Now and then, I was getting few drops of white fluid, when breast is pressed. For last one year, I have been having heavy hair fall. I thought it is due to dandruff.

Now for the last 2-3 months, I am getting pain in my breast, a week before my periods. It becomes tender, little big and I feel very uncomfortable. But on the first day of the period, the pain goes off. I went for a thyroid test; my TSH level was 5.96. My doctor prescribed Thryonorm 100 for 3 months, Primosa 1000 mg to be taken at the time of breast pain, and Cabgoline 0.5 mg twice a week for a month. Is it really important to take Cabgoline now? It’s quite expensive. Is my breast pain due to hypothyroidism? I am planning for a second baby next year. Please tell me how long will it take to control hypothyroidism. Will taking Cabgolin affect feeding to my second baby?
– By Ramya

Reply:

Have you got your T3 and T4 levels checked up? Though your TSH value is on the higher side, the blood levels of T3 and T4 need to be checked before grouping you under hypothyroidism.

T3 and T4 are the active thyroid hormones secreted by the thyroid gland. In a normal way, the gland secretes them when TSH (hormone coming from the pituitary ) stimulates it to do so.

High TSH and Low T3 to Diagnose Hypothyroidism

In hypothyroid individuals, the thyroid gland is not able to produce enough thyroid hormones (T3, T4). So pituitary releases more of TSH to provide more stimulus to the thyroid gland for hormone production. TSH levels are, therefore, high in hypothyroid patients.

However, only high TSH level value is inadequate to make a diagnosis of hypothyroidism. Blood levels of T3 andT4 (active thyroid hormones) need to be corroborated with TSH value.

Looks like you are being treated for two conditions- Under active thyroid (for which you are taking Thyronorm) and hyperprolactinemia (for which Cabgoline has being given).

Sometimes, hypothyroidism is associated with high levels of prolactin in blood. Prolactin is the main lactation hormone. High levels of prolactin in blood is called Hyperprolactinemia. Cabgoline acts to decrease prolactin levels in blood.

Causes of Hyperprolactinemia

• In a normal way, prolactin is high during the phase of lactation. It stimulates the breast to produce milk, dilates the milk ducts, swells up the milk lobules. It also acts as an anti-fertility factor. Perhaps this is natures mechanism to prevent subsequent conception when the first baby is breastfeeding.
• Pituitary tumors (Prolactinomas)
• Increased TRH production – TRH is a hormone produced from the hypothalamus (usually called the master gland). TRH acts on the pituitary and causes the release of two hormones- TSH and Prolactin. So any problem with TRH would affect both TSH and Prolactin.

What Affects TRH Release?

Hypothalamus is directly under the control of our emotions. So factors like stress, depression, anxiety etc. affect it.

It is very difficult to say at what point exactly, the problem would have initiated in your case.

Breast Pain and Fullness

It may be that you have some degree of hyperprolactinemia which is giving you these symptoms. Hyperprolactinemia has been found to occur along with hypothyroidism. However, it is better to be objective in our approach.

We would advise you to get your prolactin level in blood checked up. Only if it is high, you need to take medicine for it.

Since your breast symptoms occur just before periods and go away as the flow begins, it may be a part of premenstrual syndrome.

Premenstrual Syndrome

Just before menses, a women may perceive certain uneasy symptoms. These are grouped under premenstrual syndrome. These include:

• Fullness and engorgement of breast
• Frequent mood changes
• Flushing on face
• Bumps on face, vaginal area
• Pain in breast

Your breast symptoms could also be due to a condition called fibrocystic breast disease. This is a common condition where cystic swellings develop in the breast giving it a painful fullness feeling.

This condition may have a hormonal origin.

You need a little more evaluation. Talk to your doctor about getting T3 , T4 levels done. Also get your blood prolactin level checked. Then the treatment may be accordingly started.

We would recommend you to get these underlying conditions treated first before conceiving. All these hormonal problems interfere with conception and fetal growth. They may adversely affect the baby.

You may take about 3-4 months to get alright.

Take Care,

Buddy M.D.