Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
If a patient requires more than 5 mg per day of methimazole long term do you recommend alternative treatment options such as radio-iodine ablation or surgery?
Long term use of methimazole is generally safe as long as no history of LFT elevation or abnormally low white blood cell counts. Typically, toxic multinodular goiters respond well to low dose methimazole and patients can be managed in this fashion long-term without any issues. Graves patients may re...
Prior to gender affirming surgery, do you hold estrogen (or convert to transdermal) to minimize postoperative VTE risk?
I'd divide this into 2 sub-questions: what to do in a patient who has a history of thrombosis, and what to do in a patient without a history of thrombosis. In a patient with prior thrombosis, I would generally have them on indefinite anticoagulation alongside ongoing estrogen use. We know that trans...
Would you ever recommend radiofrequency ablation over surgery or radioiodine for a patient with an autonomously functioning thyroid nodule?
This answer can be very patient-specific, of course, in terms of preference, co-morbidities (is surgery safe), and risk of the nodule and size. I don't often do RAI for toxic adenoma /toxic MNG if the patient is a good surgical candidate or tolerates anti-thyroidals well without incident. I also hav...
What TSH cut off do you use to determine the need for levothyroxine supplementation in a pregnant patient with positive TPO antibodies?
Current ATA pregnancy guidelines recommend measuring TPO antibodies to determine the need for levothyroxine initiation in mildly hypothyroid pregnant women. However, the most recent data do not support this approach. The upcoming revision to the ATA pregnancy guidelines will no longer factor in TPO ...
How do you mitigate maternal cardiovascular risk in pregnant patients with known coronary artery disease who have discontinued statin therapy?
In patients with severe hypercholesterolemia, for example, who have HeFH, I have used a bile acid sequestrant during the pregnancy to at least lower their LDL about during this time. Having said that, I don’t know of any data supporting this. Patients with HoFH consideration for apheresis should be ...
When would you offer post-operative concurrent chemoradiation in anaplastic thyroid cancer?
The management of ATC has evolved considerably over recent years with the most significant being a dichotomy of management based on Braf mutation. We typically offer postoperative XRT, including in patients with either a limited or stable DM disease. However, in a multidisciplinary setting, there so...
Do you taper steroids more aggressively to decrease the risk of developing new-onset diabetes after transplantation in kidney transplant recipients who had pretransplant impaired fasting glucose?
Steroids are given after any transplant (kidney, heart, lung, bone marrow, etc.,) to reduce risk of rejection of the transplanted organ. Preservation of organ function is the number one concern for the transplant team. Steroid free regimens for anti-rejection are always a goal but the transition to ...
What is the preferred osteoporosis therapy after completing teriparatide in a young woman planning pregnancy within the next year?
It would be helpful to know the T-scores of the spine and femoral neck. I also like to have the bone remodeling markers. My recommendation would be adequate calcium intake of 1000 mg daily, preferably from diet, and 4000 IUs of vitamin D daily, not only to help preserve bone health, but vitamin D al...
How will the newer JCEM guidelines on primary aldosteronism (PA) impact your management and screening of PA?
I believe you are going to see more screening for PA and more assistance needed by healthcare providers on how to interpret the results. I also believe that perhaps this may lead to more use of steroidal MRA, which is a great thing for many patients having trouble with control of low-renin HTN.
Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?
While higher-intensity statins are associated with a slightly higher incidence of diabetes, it would not be recommended to start with low-intensity statins as there are no data to support this. Essentially, all of the CV outcomes trials with statins have been with moderate and high-intensity statins...