Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When, if ever, is it appropriate to switch from generic levothyroxine to brand name Synthroid?
There is almost never a need to switch from the generic Levothyroxine to a brand name if the patient is doing well and the TSH level is at target. However, if the patient is not doing well (complaining of symptoms, like feeling tired) and the TSH level is not at target, one needs to make sure that t...
Is lithium-induced hypothyroidism typically due to the production of autoimmune Hashimoto's antibodies or to the disruption of thyroid hormone production?
The answer is both. Lithium-induced hypothyroidism occurs in about 15% of patients treated with lithium. Lithium is concentrated 2-3 times higher than in serum due to uptake by the sodium iodide transporter. Hypothyroidism, in part, is due to lithium interrupting thyroid hormone production and relea...
Do you use FRAX score or BMD scores to determine whether patients with primary hyperparathyroidism would benefit from parathyroidectomy to reduce fracture risk?
I use FRAX for all patients. Basing a diagnosis of osteoporosis simply by a patient having one T-score >2.5 SD below the mean of young normal persons diagnoses only 1/3 of women older than 50 who experience a fracture of the spine, hip or wrist. FRAX uses femoral neck BMD values, as well as other re...
Do patients with hypogonadism commonly present with dizziness?
Dizziness is not a symptom associated with hypogonadism. It is possible that a cause of hypogonadism, such as a large sellar tumor that is extending into the cerebral cortex, might cause dizziness, but it would not be due to hypogonadism per se.
Does solid/trabecular type papillary thyroid carcinoma pathology confer a higher risk of recurrence and warrant radioactive iodine ablation therapy?
Solid variant papillary thyroid carcinoma (SVPTC) is a rare subtype of PTC and has been noted particularly in pediatric thyroid cancers resulting from exposure to radiation (e.g., Chernobyl). In adults, it tends to occur in somewhat older patients, which may be attributed to some reports of more agg...
For which patients with type 2 diabetes mellitus would you consider switching to once-weekly basal insulin (Awiqli)?
Once weekly basal insulin is an advance in diabetes pharmacology, but it will not be optimal for everyone. I would suggest it for people with a very stable eating and activity schedule week to week, and may have problems with adherence to or reluctance to daily basal insulin. This may work well for ...
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 is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?
I have successfully treated several patients with bisphosphonate-induced subtrochanteric femoral fractures with Forteo. However, before initiating another antiresorptive therapy, I first want to be sure that the Forteo at the desired effect on bone remodeling by increasing both bone formation and bo...
Do you recommend the use of crinecerfont in patients with congenital adrenal hyperplasia to reduce corticosteroid requirements?
Data looks good but I have not treated any patients with it.
Do you immediately discontinue sulfonylureas when initiating GLP-1 receptor agonists in patients with longstanding type 2 diabetes?
In a patient with an A1c <8% or with current issues with hypoglycemia while taking a sulfonylurea (SU), I would discontinue the sulfonylurea at the time I prescribe any highly effective medication for type 2 diabetes, including a GLP-1-based therapy. That would be with instructions to the patient to...