Questions discussed in this category
There seems to be little guidance on vitamin replacement in these patients. Vitamin K level < 50 yet PT/INR is normal. Is the vitamin K assay usefu...
A female in her early 70s, total thyroidectomy, left 1.4 cm and right 0.7 cm tall cell variant papillary thyroid cancer with clear margins and negativ...
Would your considerations change for a man vs a woman?
Butler et al., PMID 38587237
For a patient whose sodium remains 142 despite water deprivation from 8 pm to 8 am, with urine osm of about 500, is further testing needed?
Clinical scenario where an indeterminate pathology on initial FNA was followed by a “benign” result on a 2nd FNA.
Do you avoid using these agents only in patients with history of medullary thyroid cancer or pancreatic cancer? Are there other cancer risks we should...
Do anabolic agents have a role?
Viëtor et al., PMID 34503194
Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient...
Ferrell et al., PMID 38448791
Some data showed early enteral nutrition improves outcomes in DKA. Some thought that enteral nutrition could counteract the insulin gtt.
The new SCCM guidelines suggest an upper limit of 200 compared to the conventional 180.
With the time intervals recommended after taking each medicine, I am wondering how patients should be counseled.
At what doses do you start? and how do you titrate therapy?
Is this seen more with high dose vitamin D supplementation?
How would you adjust statin therapy in these patients?
Should uric acid levels be monitored regularly while on therapy?
If they are already on a preparation that contains animal products, would you change it?
Have you encountered changes in prolactin, testosterone, etc?
Would you consider testosterone therapy if he is otherwise asymptomatic?
How often do you recommend monitoring thyroid function tests in these situations?
Cholesterol Treatment Trialists' (CTT) Collaboration
Ahmad et al., PMID 36106278
Zha et al., PMID 35487459
What is your evaluation approach for RAI response? What cumulative dose do you use in practice for deciding a patient is RAI refractory?
Okubo et al., PMID 38442744
Yue et al., PMID 38554774
Normal Vitamin D, bone scan showed osteoarthritis
Dao et al., PMID 38663923
Liang et al., PMID 35900801
Chiung-Hui Peng et al., PMID 38436957
Do you base the decision off of the acuity and course of symptoms? The degree of estradiol elevation? Other factors?
Do treatments for osteoporosis have a large enough effect on tooth movement to make Invisalign less effective?
Additional risk factors could be family history of VTE or thrombophilia, such as antithrombin deficiency.
Can 25 OH vitamin D be converted to activated vitamin D outside of PTH mediated mechanisms in some organs?
No evidence for acromegaly or Pagets.
Demay, et al., PMID 38828931
The patient is actively breastfeeding.
Many patients are interested in romosozumab for "maximizing bone gain" and preventing future fractures. Some have had anabolic therapy with teriparati...
The patient has very low urinary calcium despite calcium supplements, vitamin D used to be low now normal. Continues to have elevated PTH with normal ...
Asa et al., PMID 35291028
After replacing Vitamin D, what will be your first treatment of choice? Labs including ALP and calcium levels are normal. T scores are -3 or above. Th...
There is literature showing small changes in both free T4 and TSH (despite steady state) in the first few hours after ingestion of L-T4. In occasional...
Patient is a 41F and overall good surgical risk candidate.
If so, when? Does surgery need to be timed with last dose of Prolia injection?
If not, what can be possible causes for a postmenopausal woman to have FSH, LH < 0.3 with low E2, and being asymptomatic and doing well otherwise? ...
A male patient in his 30s with two lumbar compression fractures (non-traumatic) and a Z-score of -2.6 in the spine, Z-score -0.5 in hips. History of 3...
Patient does not have hypercalcemia.
Can a diagnosis of acromegaly be made with just an elevated IGF-1 level in patients with features of acromegaly?
Conflicting data exists on whether Graves' disease would increase the aggressiveness of the concomitant thyroid cancer vs having no effect/correlation...
What dose of RAI would you consider giving if recommended?
If so, how long should OCPs be held to reliably trust the dex suppression test results?
Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortiso...
And is there a preferred diagnostic test? Whenever cyclic hypercortisolemia is suspected, it is advised that evaluation should be repeated for months,...
I’ve seen several such patients who have no secondary causes for bone loss, on adequate calcium/vitamin D, and compliant with denosumab who do n...
Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigu...
Should this patient population be treated differently?
At our institution, we have started using EPIC to screen many patients for osteoporosis and ou...
The female patient is in her late 70s with cardiac disease (likely due to chronic hyperthyroidism that was missed due to non-suppressed TSH). I’...
Elderly male with primary hypothyroidism, HTN, and progressive worsening cognition over several months. PCP has been increasing LT4 dose as outpatient...
Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC?
No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.
The patient has no personal history of VTE, but has positive family history of VTE.
Any prophylactic anticoagulation options?
How would manage...
For pts w/ eGFR between 30-60
Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).
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