Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do patients with hypogonadism commonly present with dizziness?
"Brain fog" and/or fatigue, but none have complained of dizziness.
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...
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...
How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?
Phentermine has been available since 1959 and remains an affordable and effective medication option added to a full lifestyle-based weight management plan. In people who are generally healthy and without contraindications to the medication, I have had patients used in at least intermittently for sev...
Is it safe to use acarbose in patients with advanced chronic kidney disease?
Yes, I think so.