The Relationship of Changes in Serum Estradiol and Progesterone during the Menstrual Cycle to the Thyrotropin and Prolactin Responses to Thyrotropin-Releasing Hormone*

The responses of serum TSH and PRL to TRH (500 μg) were studied in normal young women in the early follicular, periovulatory, and midluteal phases of the menstrual cycle in order to examine the relationship of these responses to the levels of estradiol (E2) and progesterone. Each woman was studied twice in each phase in order to assess intraindividual variability. There was no significant difference in either the TSH or PRL responses among the phases of the menstrual cycle nor was either response affected by the periovulatory rise in E2 or by the luteal rise in both E2 and progesterone. Thus, the interpretation of the TSH and PRL responses to TRH in normal women is not affected by the menstrual cycle although both responses are greater in women that in men. Both the peak TSH and peak PRL after TRH were highly correlated with the basal levels of TSH (r = 0.85; P < 0.01) and PRL (r = 0.67; P < 0.01), respectively, indicating that the TSH and PRL responses to TRH in women are directly proportionate to the basal levels of the respective hormones, as previously shown for the TSH response in men. The mean intraindividual variability (coefficient of variation) of the TSH response to TRH was 18%, but ranged as high as 56%, while that of the PRL response was 16% and ranged up to 31%; variability was not affected by the phase of the menstrual cycle. The normal range of the peak TSH after TRH in women is 7–33 μU/ml (mean ± 2 sd); however, because of the variability, a normal woman may sometimes have a peak TSH after TRH as low as 4 μU/ml. Repeating the test will result in a normal value if the woman is truly normal. Similarly, the normal peak PRL after TRH in women is 22–111 ng/ml (mean ± 2 sd); usually, however, the lower limit is 30 ng/ml with lower values due to intraindividual variation. The data suggest that the higher average level of E2 in women compared to men may account for the greater responses in women, but that the cyclic changes in serum E2 or progesterone in women have little or no additional effect.