Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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 patients with hypogonadism commonly present with dizziness?
"Brain fog" and/or fatigue, but none have complained of dizziness.
Does solid/trabecular type papillary thyroid carcinoma pathology confer a higher risk of recurrence and warrant radioactive iodine ablation therapy?
Solid variant papillary thyroid carcinoma (SVPTC) is a rare subtype of PTC and has been noted particularly in pediatric thyroid cancers resulting from exposure to radiation (e.g., Chernobyl). In adults, it tends to occur in somewhat older patients, which may be attributed to some reports of more agg...
For which patients with type 2 diabetes mellitus would you consider switching to once-weekly basal insulin (Awiqli)?
Once weekly basal insulin is an advance in diabetes pharmacology, but it will not be optimal for everyone. I would suggest it for people with a very stable eating and activity schedule week to week, and may have problems with adherence to or reluctance to daily basal insulin. This may work well for ...
What is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?
I have successfully treated several patients with bisphosphonate-induced subtrochanteric femoral fractures with Forteo. However, before initiating another antiresorptive therapy, I first want to be sure that the Forteo at the desired effect on bone remodeling by increasing both bone formation and bo...
Do you recommend the use of crinecerfont in patients with congenital adrenal hyperplasia to reduce corticosteroid requirements?
Data looks good but I have not treated any patients with it.
Do you immediately discontinue sulfonylureas when initiating GLP-1 receptor agonists in patients with longstanding type 2 diabetes?
In a patient with an A1c <8% or with current issues with hypoglycemia while taking a sulfonylurea (SU), I would discontinue the sulfonylurea at the time I prescribe any highly effective medication for type 2 diabetes, including a GLP-1-based therapy. That would be with instructions to the patient to...
Is it safe to use acarbose in patients with advanced chronic kidney disease?
Yes, I think so.
How do you discuss the importance of ongoing lifestyle-based interventions when starting a GLP-1 agonist for medically relevant obesity (i.e., with comorbid conditions)?
I discuss the importance of ongoing lifestyle interventions by going back to the primary research for the corresponding GLPs. I point out the fact that in many of the trials, both the control group and the experimental groups would have some form of therapeutic lifestyle change (usually a mix of edu...
Is the presence of ubiquitin-specific peptidase 8 (USP8) genotype helpful in determining the risk of Cushing disease recurrence?
Indeed, a recent retrospective, multicenter, international study (Zhang et al., PMID 41785910) reported that patients with USP8-variant tumors are more likely to experience recurrence of Cushing's disease in comparison with patients with microadenomas that are USP8-wildtype (37% vs. 15% at 10 years)...