Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is it a good practice to prescribe clonidine to take as needed for occasional severe blood pressure elevations?
Prescribing as needed clonidine is not part of my routine BP management. If the BP is uncontrolled consistently then long-acting medications can be uptitrated or dose adjusted. As needed clonidine may be helpful in the initial evaluation period or when making medications changes. It is important for...
What are your preferred lipid-lowering agents and target LDL reduction goal following initiation of therapy for patients with familial hyperlipidemia without underlying CAD?
It is not easy to address this question without specifics of the 'familial hyperlipidemia," but I will give examples: Monogenic familial hypercholesterolemia - since the LDL is very high from early childhood, we tend to treat adolescents with statins with a goal of a 50% reduction (20 or 40 rosuvas...
How do you counsel patients that are positive for both stimulatory and inhibitory autoimmune thyroid markers (TRAb, TSI and TPO Ab) regarding their likelihood of flipping from hyperthyroidism to hypothyroidism?
I do not measure multiple thyroid antibodies simultaneously at the time of initial diagnosis, so this is typically not a conversation I would have at initial patient presentation. My usual practice is to check a TSI in patients with hyperthyroidism and a TPO in patients with new hypothyroidism. In p...
Would you recommend RAI ablation therapy to patients with PTC who are s/p hemi-thyroidectomy and decline completion thyroidectomy despite meeting criteria based on pathology results?
RAI therapy will work to ablate the remaining thyroid lobe with about a 69% success rate using a high dose of I-131. However, extra-thyroidal tumor cells will likely not pick up I-131 with this treatment. A good reference is the 2020 meta-analysis in the Journal of Nuclear Medicine: Piccardo et al.,...
Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?
This test indicates that this patient has fairly good urinary concentrating ability, but does not meet most criteria for "normal" since the osmoles did not go over 600. Since diabetes insipidus is a spectrum disorder, this result does not completely rule out the possibility of very mild diabetes ins...
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...
How do you recommend mitigating the risks of using beta blocker and clonidine therapy in combination for management of hypertension?
Beta blockers vary in lipophilicity, which affects blood-brain barrier permeability. Propranolol and metoprolol readily cross the blood-brain barrier, while other beta-blockers like nebivolol do not. The CNS side effects of fatigue, depression, and insomnia are more likely to worsen if using a lipop...
Do you order MODY genetic testing to discontinue unnecessary treatments such as insulin or metformin in patients misdiagnosed as either Type 1 diabetes or Type 2 diabetes?
First, I like the term Monogenic Diabetes better than MODY because it captures the concept of a single-gene mutation to distinguish it from the multi-gene/environmental factors in T1DM and T2DM. I think screening for monogenic diabetes should be considered in patients with atypical features of T1DM ...
In compensated MASH cirrhosis with frailty/sarcopenia, how do you use GLP-1 receptor agonists safely—what lean-mass or functional monitoring strategy (and stopping/adjustment thresholds) do you use to prevent harmful weight-loss–associated muscle loss while pursuing cardiometabolic benefit?
In compensated MASH cirrhosis with frailty or sarcopenia, I use GLP-1 receptor agonists cautiously (and for non-MASH indications) and pair them with structured resistance exercise 2 days a week, adequate protein intake (1.2-1.5 g/kg/day), and baseline functional assessment rather than focusing on we...
Are thyroid molecular tests (such as Afirma, ThyroSeq) validated for use on FNA thyroid nodule samples that are not Bethesda class 3-4?
If the first biopsy was AUS and the second biopsy was Bethesda II, benign, the molecular test is not warranted. It is agreed that a second biopsy of a nodule that was AUS (Bethesda III) will be benign about 40% of the time. If the first biopsy was follciular neopasm/suspicioyus for FN (Bethesda IV),...