Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you consider the use of romosozumab in men who have failed therapy with teriparatide and sustained multiple vertebral fractures?
Yes, I would consider Romosozumab for the male patient. I would check his cardiovascular status due to concern of the possible increased risk for a cardiovascular event on the medication, which could be a contraindication. However, before initiating therapy, it would be helpful to know some of the s...
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 on timing of their medications when they are taking both oral semaglutide and levothyroxine?
I have no personal experience with the situation that you describe. However, it is well known that Levothyroxine should be taken on an empty stomach, because several foods such as high fiber meals, coffee, calcium, and iron supplements can bind to levothyroxine and significantly reduce its effective...
What doses of methimazole do you consider "low dose" when treating Graves' disease long-term?
"Low dose" methimazole is traditionally considered to be doses of <5-10 mg a day, but I think the definition should be 5 mg or less a day. Indeed, some patients can be controlled on 2.5 mg a day, and I have several patients with normal thyroid function who have taken 2.5 mg every other day for sever...
Would you prescribe testosterone to a post-menopausal woman for low libido and/or fatigue symptoms assuming all other work up is unremarkable?
I have never prescribed testosterone to women for decreased libido, if the other workup is normal. In addition, if you explain the side effects, such as increasing hirsutism, most women opt out of taking testosterone for this purpose.
When would you consider treating growth hormone deficiency in surgically treated acromegaly with longstanding low IGF-1 levels?
I would not treat unless there are clinical features of GHD.
Is there a maximum duration for raloxifene use?
There is relatively scant data on long-term raloxifene use in patients with osteoporosis, but generally, there are no recommendations for a drug holiday. The primary endpoint in the pivotal registration trial, MORE, was incidence of vertebral fracture, and the difference between the raloxifene and p...
Can estradiol patches be prescribed once weekly instead of twice weekly for the treatment of postmenopausal symptoms?
It depends on the formulation of the patch but it can be hard to have patches stay on for a week, leading to symptoms if they fall off.
Should long-acting subcutaneous insulin be started upfront in addition to regular insulin infusion for patients with diabetic ketoacidosis?
Current ADA guidelines suggest patients with uncomplicated mild or moderate DKA may be treated with subcutaneous rapid-acting insulin analogs every 1-2 hours as an effective alternative to IV insulin, but still only recommend IV short-acting insulin by continuous infusion for moderate-severe DKA. Ho...
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.