Q. Which factors can affect the FSH level?
The levels of FSH can get affected by conditions like uncontrolled thyroid disease, sex-dependent hormone tumors, ovarian cysts, and unusual vaginal bleeding. Moreover, medicines like birth control pills, cimetidine, clomiphene, digitalis, levodopa, phenothiazines as well as medicines used in hormone replacement therapies can also affect the levels. Similarly, medicines used in hormone replacement therapies can also alter the FSH levels.
Multivitamins containing biotin or vitamin B7 may also affect the accuracy of the FSH test. It is generally advised that a woman should avoid taking these supplements for at least 12 hours before a test.
Q. What do high levels of FSH indicate?
High levels of FSH can indicate loss of ovarian function or ovarian failure, menopause, polycystic ovarian syndrome, chromosomal abnormalities (e.g., Turner’s syndrome), and reduction in the production of good quality eggs and embryos for fertilization.
Q. What are the causes of high levels of FSH in Men?
High levels of FSH in men may indicate Klinefelter’s syndrome, absence of testicles or impaired functioning of testicles, damage to testicles by a disease such as alcohol dependence, and testicular damage by treatments such as X-rays or chemotherapy.
Q. What are the causes of high levels of FSH in Children?
The start of puberty might be the cause for high levels of FSH in children.
Q. What do low levels of FSH mean?
Low levels of FSH may indicate decreased ovulation in women, reduced sperm count in men, problems at the level of the hypothalamus or pituitary gland, which are the hormone control centers in the brain, and stress.
Q. Can medicines have any effect on the levels of FSH?
There are certain medicines that can affect the levels of FSH. In order to prevent false readings, it is important for the individual to inform the doctor about all the medicines they are taking as they can alter the functioning of hormones.
Medicines that could increase FSH levels include cimetidine, clomiphene, digitalis, and levodopa. Whereas, medicines that decrease FSH levels include hormone replacement therapies, oral contraceptives, and phenothiazines.
Taking multivitamins that contain biotin or vitamin B7 may also affect the accuracy of the FSH test. Doctors usually recommend that a woman should not take these supplements for at least 12 hours before a test.
Q. Can levels of FSH vary during different days of the menstrual cycle?
Yes, the FSH level can vary during the different phases of the menstrual cycle. Following are the normal range during different phases:
Follicular phase: 3.1-7.9 mIU/ML
Ovulation phase: 2.3-18.5 mIU/mL
Luteal phase: 1.4-5.5 mIU/mL
FSH levels can vary not only throughout the menstrual cycle but also from cycle to cycle. You can get a normal test value one month and an abnormal test value the next.
Hence, to test basic fertility and to evaluate ovarian reserves, the FSH level is checked on day 3 of the menstrual cycle. The first day of the cycle is the day when the period begins.
Reference range may vary from lab to lab*
l range during different phases:
Follicular phase: 3.1-7.9 mIU/ML
Ovulation phase: 2.3-18.5 mIU/mL
Luteal phase: 1.4-5.5 mIU/mL
FSH levels can vary not only throughout the menstrual cycle but also from cycle to cycle. You can get a normal test value one month and an abnormal test value the next.
Hence, to test basic fertility and to evaluate ovarian reserves, the FSH level is checked on day 3 of the menstrual cycle. The first day of the cycle is the day when the period begins.
Reference range may vary from lab to lab*
Q. How LH test results are interpreted in women?
In women, there are two types of ovarian failure, primary and secondary. This test helps to analyze LH and FSH levels which can in turn help to differentiate between the two types of ovarian failure. Primary ovarian failure is when the problem is within the ovaries or there is a lack of ovarian development. However, secondary ovarian failure occurs due to disorders of either the pituitary gland or the hypothalamus.
Primary ovarian failure: In this, the levels of LH and FSH rise. The following can be some causes of primary ovarian failure:
· Developmental defects: Failure to develop ovaries (ovarian agenesis)
· Chromosomal abnormality: Turner syndrome
· Defect in steroid production by the ovaries such as 17 alpha-hydroxylase deficiency
· Premature ovarian failure due to exposure to radiation, chemotherapy, and autoimmune disease
· Chronic failure to ovulate (anovulation) due to polycystic ovary syndrome (PCOS), adrenal disease, thyroid disease, and ovarian tumor
· Menopause: In this, a woman's ovaries cease to function; thus, it results in increased levels of LH.
Secondary ovarian failure: In this, low levels of LH and FSH are observed which indicates a problem with the pituitary gland or hypothalamus. Here, LH response to GnRH can help differentiate between secondary dysfunction and tertiary disorder (a problem involving the hypothalamus). Following baseline level of LH measurement, a dose of GnRH is given by injection. A subsequent increase in LH level shows that the pituitary gland responded to the GnRH and indicates a disorder involving the hypothalamus. However, a reduced level of LH shows that the pituitary gland did not respond to the GnRH and suggests a disease involving the pituitary gland.
Q. How LH test results are interpreted in men?
Primary testicular failure: High levels of LH may indicate primary testicular failure. The following can be the causes:
· Developmental defects: Failure to develop gonads (gonadal agenesis)
· Chromosomal abnormality such as Klinefelter syndrome
· Testicular failure: Viral infection (mumps), Trauma, Exposure to radiation, Chemotherapy, and Autoimmune disease
· Germ cell tumor
· Testicular injury
Secondary failure: Low levels of LH and FSH can be seen in case of secondary failure of the testicles. This may indicate a problem with the pituitary gland or hypothalamus.
Q. How LH test results are interpreted in children?
In young children, high levels of LH and FSH with the development of secondary sexual characteristics at an unusually young age are an indication of precocious puberty. Usually, this premature development is due to impaired functioning of the central nervous system. It can also have a few different underlying causes such as:
· Central nervous system tumor
· Brain injury, trauma
· Inflammation within the central nervous system (e.g., meningitis, encephalitis)
· Brain surgery
Normal prepubescent levels of LH and FSH in children showing some signs of pubertal changes may indicate a condition called "precocious pseudopuberty". The signs and symptoms are caused by elevated levels of the hormones estrogen or testosterone. This may be caused by:
· Hormone-secreting tumors
· Adrenal gland tumors
· Ovarian tumors or cysts
· Testicular tumors
However, normal FSH and LH levels with a few signs of puberty can also indicate a benign form of precocious puberty, with no underlying or discernible cause, or may just be a normal variation of puberty.
In delayed puberty, LH and FSH levels can be normal or below considerable range. The test for LH response to GnRH in addition to other tests may help to diagnose the reason for the delayed puberty. Some of the underlying causes of delayed puberty can include:
· Failure of the ovaries or testicles
· Hormone deficiency
· Turner syndrome
· Klinefelter syndrome
· Chronic infections
· Cancer
· Eating disorder (anorexia nervosa)
Q. How is the blood sample taken?
The healthcare provider takes a blood sample from the arm. The site from where the blood is to be withdrawn is cleaned with a swab of rubbing alcohol. This is then followed by inserting a small needle which has a tube attached to it for collecting blood. Once the sufficient blood for analysis is withdrawn, the needle is removed. The site is then covered with a gauze pad.
Q. Is there any risk associated with the withdrawal of blood sample procedure?
As such there is no risk but in few cases, bruising, bleeding, and infection at the puncture site can be seen. In very few cases, there can be swelling of the vein after the blood is withdrawn.
Q. Is prolactinoma considered a cancerous tumor?
No, prolactinoma is not a form of cancer. It is a benign tumor of the pituitary gland which means it is simply overgrowth of cells in the pituitary gland.
Q. Is prolactin hormone present in men?
Yes, prolactin hormone is present in men. High levels of prolactin have been associated with low sex drive and decreased erectile function.
Q. Does high prolactin levels affect the levels of testosterone?
Yes, high levels of prolactin can cause erectile dysfunction, as the levels of testosterone start to decrease.
Q. How can hyperthyroidism affect pregnant female and her baby?
An untreated hyperthyroidism during pregnancy can lead to miscarriage, premature birth, low birth weight, preeclampsia (a very high rise in blood pressure in late pregnancy), thyroid storm (a sudden, severe worsening of symptoms of hyperthyroidism), and congestive heart failure.
Q. How can hypothyroidism affect pregnant female and her baby?
Untreated hypothyroidism during pregnancy can cause preeclampsia (a very high rise in blood pressure in late pregnancy), anemia, miscarriage, low birth weight, stillbirth (death or loss of a baby before or during delivery), and congestive heart failure, although in rare cases.
These problems occur most often with severe hypothyroidism.
As the thyroid hormones play an important role in the development of baby’s brain and nervous system, untreated hypothyroidism—especially during the first trimester—can cause low IQ and other problems with normal development.
Q. Which medicines can affect the levels of Prolactin hormone?
Certain drugs can cause a low level of Prolactin such as Dopamine (used in conditions like shock), Levodopa (used for Parkinson’s disease), or Ergot alkaloid derivatives (used for severe headaches). However, certain drugs can cause elevated levels of Prolactin such as CNS depressants, Estrogen, drugs used for the treatment of hypertension (e.g., Reserpine, Verapamil, Methyldopa), and drugs used for treating gastroesophageal reflux like cimetidine.
Q. What is prolactinoma?
Prolactinomas are tumors which are usually benign (non-cancerous) of the pituitary gland in which there is production of high amounts of prolactin. These are more common in women as compared to men. Prolactinomas may cause menstrual irregularities, infertility, and bone loss in women. However, in men it can cause erectile dysfunction, gynecomastia (breast enlargement), decreased muscle mass, and bone loss. If the size of the tumor is quite large, it can cause pressure symptoms like headache and problems of the vision.
Q. What is Hyperthyroidism?
Hyperthyroidism is a condition in which the thyroid gland is overactive and there is an increased production of thyroid hormones by the thyroid gland. Causes of Hyperthyroidism include Graves’ disease, multinodular goiter, thyroid nodules, toxic adenoma, inflammation of the thyroid, eating too much iodine, and too much synthetic thyroid hormone. Diagnosis of this condition can help to relieve the symptoms and prevent long-term complications.
Q. What are the symptoms of Hyperthyroidism?
Symptoms of Hyperthyroidism include: Rapid heartbeat (tachycardia) — commonly more than 100 beats/minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations), sudden weight loss, nervousness, anxiety, irritability, tremor (usually a fine trembling in your hands and fingers), changes in menstrual patterns, increased sensitivity towards heat, changes in bowel patterns (especially more frequent bowel movements), an enlarged thyroid gland (goiter) which may appear as a swelling at the base of your neck, increased appetite, sweating, fatigue, muscle weakness, sleep disturbances, skin thinning, fine and brittle hair.
Q. What is Hypothyroidism?
Hypothyroidism, also called underactive thyroid or low thyroid is a condition in which the thyroid gland does not produce enough thyroid hormones. It can be commonly caused by intake of low iodine diet or Hashimoto's thyroiditis (an autoimmune disease). Less common causes include previous treatment with radioactive iodine, injury to the pituitary gland which secretes TSH, intake of certain medicines, previous thyroid surgery, or a lack of a functioning thyroid gland at birth.
Q. What are the symptoms of Hypothyroidism?
Hypothyroidism can cause symptoms such as tiredness (fatigue), hoarseness, constipation, feeling cold, dry skin, dry and thin hair, puffy face, weight gain, and muscle weakness. Along with that, one may experience decreased sweating, depression, slowed heart rate, increased blood cholesterol levels, pain, and stiffness in your joints, impaired memory, problems of infertility or menstrual changes, muscle stiffness, aches, and tenderness.
Q. What are the causes of high TSH in a newborn?
Congenital hypothyroidism is an important cause of elevated thyroid-stimulating hormone (TSH) in newborns. Other causes of an elevated TSH include transient hypothyroidism due to neonatal illness, premature birth, iodine excess or deficiency. High TSH can also be seen in case the mother is taking some medicines that could affect thyroid hormone levels or the mother has some underlying thyroid disease.
