PRL and Menstrual disorder: In addition, some cases of SITSH can have galactorrhea or menstrual disorder due to increased levels of prolactin (PRL) and/or decreased levels of luteinizing hormone (LH) or follicle stimulating hormone (FSH), as well as increased levels of TSH.[1, 2, 3, 4, 5, 6] When we fail to recognize the presence of SITSH, thyroid ablation may be needed to further expand the pituitary tumor volume.