I would not recommend a mom take more than 80 mg/day of domperidone, because 
of the case reports of cardica arrhythmias from IV use.  I would not be 
comfortable "pushing" up the does that way.  But I do know women who have.

It is impossible to say what has happened in the mom Jaye 
describes...especially weeks/months after birth.  It could have been poor 
milk removal by baby initially.  If she has a family history of thyroid 
issues, and because she has had infertility issues, I would recommend some 
labwork be done to rule out some things.  TSH, HCG, testosterone, and to be 
complete she should have a prolactin done before and 30 minutes after the 
beginning of a feeding to document a rise.

I have seen 3 moms in the past month with very little to no milk production 
(and minimal to no breast changes during pregnancy) who had thyroid issues. 
One had hyperthyroidism diagnosed during the pregnancy, one was on thyroid 
replacement after a prior ablation, and one said she has a rare T3 
abnormality she is not treated for.  My guess is that there is a LOT we do 
not know about how critical which hormones are in what ratios during breast 
development during pregnancy.  These are very frustrating situations.  Some 
moms are satisfied with that much of an explanation, and some want to do 
labwork to try and "know" what the problem is.  The truth is, the only 
things we can DO anything about are retained placenta ( high HCG and 
bleeding/cramping) or low thyorid...although I have yet to see a woman who 
adjusting or adding thyoid replacement after birth really made a big 
difference in supply.  A high testosterone gives you a reason (theca-lutein 
cyst) but you just have to wait for levels to drop.

Sorry for the long post-

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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