Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is the clinical significance of a paradoxical decrease in HDL cholesterol after starting statin therapy?
I agree that the modest/minimal changes in HDL upon starting statin Rx are likely clinically meaningless. During the "statin-wars" that were all we heard about from different pharma sources, but it is probably related to a large drop in total cholesterol flux through the circulation - maybe CETP is ...
When and how should we be stopping GLP-1 Receptor Agonist/Dual Agonist therapy?
I usually continue for 3-4 years, the tapering down slowly over 1 year period, buy then the set point for energy expenditure and appetite likely is changed.
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Is it safe to discontinue prenatal vitamins that contain biotin for a few days during pregnancy when labs in particular thyroid tests are planned for treating hypo or hyperthyroidism in pregnancy?
Biotin doses of 5-10 mg can impact TFTs. Most prenatal vitamins contain 30-35 mcg of biotin (although there are some that contain up to 500 mcg of biotin). This is usually too low to cause assay interference, so I do not recommend cessation of prenatal vitamins prior to TFTs (although I will ask tha...
How do you approach the frequency of DEXA scan monitoring for older adults on bisphosphonate therapy during the course of therapy?
Depends who you read. ACP: Recommendation 4: ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence) [1] Monitoring wasn't addressed in the 2023 update. ACR: For adults continuing...
How do you manage microprolactinomas in women who are resistant to dopamine agonists, especially considering potential tumor growth during pregnancy?
Microprolactinomas rarely grow during pregnancy, so clinical monitoring is appropriate. If infertility becomes an issue and the patient is unable to tolerate a dopamine agonist or doesn't respond, which is rare, surgery is an option.
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...
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...