A prolactin of 200 for a mother of a 4 week old strikes me as normal, 
not high. The lab might have flagged it as high, because it uses 
non-lactating women as the norm. I once had a mother of a similar aged 
baby with low milk production tell me her prolactin was "normal", when 
we called the doctor for the number it was 32. Clearly insufficient to 
maintain lactation. She was much more successful in making milk when she 
started domperidone, prescribed by a local physician.

I'd be more concerned about the hypothryoidism. If mom has been 
hypothyroid for some time, she might not have normal breast development. 
Bringing mom "well into the normal range" for her thyroid hormones is 
recommended, but this doesn't always compensate for being hypothyroid 
during pregnancy or puberty. If it's just postpartum thyroiditis, 
supplementing her should help.

Catherine Watson Genna, BS, IBCLC  NYC

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