Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How far in advance of a nuclear medicine thyroid update and scan should thionamides be discontinued and does this duration vary based on radio-isotope used (i.e. technetium versus RAI 123)?
The length of time I hold the thionamide depends on the nature of the underlying thyroid disease rather than the isotope used. If the patient is mildly hyperthyroid or well-controlled on low-dose thionamide (such as in a toxic nodule or toxic MNG), then I will hold the medication longer (1-2 weeks)....
How should PCOS be addressed after menopause?
I approach all patients with PCOs by assessing their risks and their main concerns. Premenopausal women are frequently concerned about irregular menses, infertility and hyperandrogen symptoms. For post menopausal women, the hyperandrogen symptoms continue and I will manage with spironolactone, consi...
Is there any evidence that spironolactone or finasteride therapy increase blood levels of testosterone?
Yes. It seems that both medications can do this at least in the short term. Spironolactone's effect may be more temporary.For spironolactone, an older article: Tidd et al., PMID 152681For finasteride: Stanczyk et al., PMID 23474436
Would you recommend waiting for a low Vitamin D level to correct to goal prior to giving a scheduled Prolia injection when transitioning a patient from Zolendronic acid to Prolia therapy for worsening osteoporosis?
When ZA is in its early days patients had to have a D level of 15ng/ml. To be on the safe side most of us want a 25 ng/ml level which is easy to obtain.
What is your experience with using anabolic therapy for treatment of osteoporosis in patients with EtOH cirrhosis and is one agent preferred over another (PTH analogue vs Evenity)?
The approach that has been recommended may be reasonable. It is important to recognize that a bone density score consistent with osteoporosis does not necessarily mean that the patient has osteoporosis i.e. loss of mineral and matrix. Osteomalacia, a mineralization defect of the collagen elastin mat...
Are SGLT2 inhibitors contraindicated in patients with osteoporosis and history of vertebral and hip fractures?
In ovariectomized mice, the GLP-1 agonists were found to improve bone density by reducing the inflammation in the bone marrow so there is no contra-indication for a patient with osteoporosis and vertebral fractures to take this class of medications. It is the first weight loss therapy that is not as...
Is the 6-month post-operative calcium level a good indicator of patients' risk of recurrence of primary hyperparathyroidism?
Probably, yes - see recent study: Hellums et al., PMID 40705364.
Would you recommend changing a patient from the pill form of levothyroxine to Tirosint-SOL if they are started on a proton pump inhibitor?
While it is true that PPI's may lead to a decrease in levothyroxine absorption due to decreased tablet dissolution in the stomach (Guzman-Prado et al., PMID 33469743), and that liquid formulations are not susceptible to this effect (Seng Yue et al., PMID 38554774), the decrease in levothyroxine abso...
Would you start anabolic agents for osteoporotic hip fracture healing?
There are two relatively well-done trials for tptd for fracture healing of the proximal femur. There was a Phase 3 trial for femoral neck fractures. The FDA made it quite complicated and demanded 2 separate trials of 1,200 patients each. The trials were 3 years in duration with many difficult outcom...
How do you evaluate remission in acromegaly when postoperative IGF-1 and GH levels are discordant?
It depends how long after surgery. IGF-1 may take up to 3 months form curative surgery to normalize. If GH is low (<0.4 ng/mL) and IGF-1 is still abnormal and you are less than 3 months form surgery, I would just wait. If the opposite is true (Normal IGF-1 but elevated random GH), I would perform a ...