Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Do you foresee any added benefit of triple agonist therapy (GLP-1, GIP and glucagon) for glycemic control in patients with Type 1 diabetes mellitus?
There are a number of triple agonists under development. Furthest along is retatrutide with average weight loss approaching 30% in the setting of obesity. GLP-1 receptor agonists have definitively demonstrated weight loss benefits in people living with type 1 diabetes. Glycemic benefits have emerged...
What is the evidence, if any, for the use of low dose naltrexone in the treatment of autoimmune thyroiditis?
I do not prescribe naltrexone for thyroid disease because I have not found data to support its use. In theory, low dose naltrexone (LDN) could decrease inflammation and thus potentially block development of overt hypothyroidism in TPO positive patients. But, at this time, it is anecdotal, with no ha...
What oral contraceptives pills do you favor for treatment of PCOS?
Oral contraceptives in women with PCOS are used for multiple indications, including pregnancy prevention, endometrial protection, menstrual irregularity, and cosmetic issues (hirsutism, acne, alopecia). Combination OCPs can accomplish all these goals. One concern with combination OCPs is that the pr...
In patients with T1DM, when would you consider the use of amylin analogues for control of post prandial hyperglycemia?
Pramlintide was FDA-approved in 2005 after demonstrating modest A1C reduction, improvement in post-prandial hyperglycemia, no increase in hypoglycemia, and some weight loss. I prescribed it to several of my patients with type 1 diabetes. Unfortunately, many of them had challenges such as GI side eff...
How do you determine the appropriateness of starting a CGM in patients aged 75 and older with type 2 diabetes on multiple daily insulin injections?
In general, the profile of T2D on MDI is a compelling indication for CGM. The wrinkle here is "age 75 and older". Though our gut instinct is that if the base case is compelling, the case should be stronger for those aged 75 and older. Specifically, avoiding hypoglycemia is critical to keep elders we...
Is there any benefit to trend testosterone and DHEA-S levels in patients with PCOS to determine response to therapy?
A recent guideline for the diagnosis and management of PCOS in patients states: “Repeated androgen measures for the ongoing assessment of PCOS in adults have a limited role” (International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023). That said, I thi...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
Is inositol just as effective as metformin in treating insulin resistance associated with PCOS?
Myo-inositol (MYI) and its metabolite D-chiro inositol (DCI) are over-the-countersupplements that have been suggested to improve insulin action in patients with PCOS. Outside of the PCOS world, there doesn’t seem to be much traction to using MYI over metformin for pre-diabetes and I believe it is no...
Would you start low dose methimazole therapy in patients with positive TRAb, normal FT4 and FT3 levels but ongoing TSH suppression in a completely asymptomatic young patient?
Yes, if TSH is <0.1, I would start Methimazole. The TRAb indicate higher risk of progressing to overt hyperthyroidism.As per European Thyroid guidelines, you can consider it, but it is at clinician's discretion: "Endogenous mild or subclinical hyperthyroidism (SH) is associated with increased risk o...