Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What are some advantages of Veligrotug over Tepezza for the treatment of thyroid eye disease?
Tepezza is FDA-approved and currently in use. Veligrotug is being reviewed by the FDA. While the early released data suggest it is safe and improves thyroid eye disease (TED), before answering this question, we need to wait until the data are fully available and published. It is currently under FDA ...
How do you screen (imaging, modality) for bone density changes following oncologic treatment in childhood cancer survivors?
Certain survivors of childhood cancer are at risk for reduced bone mineral density, especially those exposed to extensive corticosteroids or radiation, hypogonadism, growth hormone deficiency, and those who have had reduced weight-bearing/mobility for an extended period of time. It is important to s...
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...