Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
For patients with Hashimoto's thyroiditis, is there a commercially available blood test for detecting abnormalities in the type 1 deiodinase enzyme in order to identify patients who would potentially benefit from T4 and T3 combination therapy?
Most clinicians decide to use combination therapy based on a weak response to levothyroxine, with patients still complaining of symptoms related to hypothyroidism. The TSH should not be low before selecting dual replacement.
Do you routinely check vitamin K levels in post-bariatric surgery patients?
Vitamin K levels are not checked routinely in post-bariatric surgery patients. Deficiency of this vitamin is very uncommon in patients who have undergone a sleeve gastrectomy and even with Roux-en-Y gastric bypass. There is more potential for deficiency in patients who have had biliopancreatic diver...
How does a mildly elevated CBG (cortisol binding globulin) level affect the interpretation of the 1mg overnight dexamethasone suppression test results?
We usually do not measure CBG level during the 1-mg DST. If a woman is on oral estrogen, one may wait for the total cortisol level; if abnormal, repeat the test with free cortisol measurement or measure free cortisol proactively to avoid delays in test interpretation. A nice paper from the Mayo Clin...
Is there an available ASCVD risk calculator that does not exclude patients on statin therapy?
The traditional pooled ASCVD risk calculator cannot be used in patients on lipid-lowering therapy. The new PREVENT (Predicting Risk of CVD EVENTs) risk calculator, which was developed by the AHA in 2023, can be used in patients on lipid-lowering therapy. It gives an estimate of 10- and 30-year risk ...
Do you routinely prescribe vitamin D to reduce the risk of fall-related fractures in elderly patients regardless of their serum levels?
Right now, the evidence would NOT support daily vitamin D in older adults who are not deficient just for the purposes of fall prevention. Kahwati et al., PMID 33847712However, lots get missed on fall prevention - so be sure to review all risk factors and make a personalized plan (STEADI resources ar...
Would you consider adding metformin to the regimen of a diabetic patient with a benign thyroid nodule to decrease its volume?
No. The evidence for this is of fairly low quality. I would, however, add it for their diabetes 100%.
Under what circumstances would you consider a bone biopsy in the workup of renal osteodystrophy?
I am always in favor of doing more diagnostic tests. The problem is that it is often practically hard to get a bone biopsy. I would suggest it anytime there a question of what is happening with the bone disease.
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 ...
What is the role of metformin in treating Hashimoto's disease?
It does not currently have one. While there is limited data showing Metformin decreases antibody levels and can lower TSH, there is minimal data showing if there is any clinical benefit as a result (or what the impact on T4 or T3 is). Further research would be needed before Metformin could be consi...
How do you manage orthostatic symptoms from autonomic neuropathy due to diabetes?
Try conservative measures such as hydration, pressure stockings, abdominal binder, exercises, and precautions prior to positional change. Addition of midodrine or other medications like flourinef and adjustment of doses of their antihypertensive medications. There are other medications that can be u...