Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should all thyroid cancer patients have thyroglobulin levels measured pre-operatively?
Should all patients be tested? No A] Situations where TG might play a supportive role: In a rare patient with pathological bone fracture due to bone metastasis as a presenting manifestation of thyroid cancer. This is an uncommon presentation, where in TG estimation may assist in the diagnosis. Sim...
What is the recommended workup for PTH-independent hypercalcemia secondary to an elevated 1,25-dihydroxyvitamin D level?
I presume what is meant is that the PTH is suppressed, and therefore, with an elevated 1,25-dihydroxyvitamin D concentration, it is likely the primary cause? The 2 major causes for elevated 1,25-dihydroxyvitamin D when serum 25-hydroxyvitamin D is normal or sometimes low are due to either a granulom...
Do you recommend prescribing methimazole to prevent iodinated contrast media-induced exacerbation of thyrotoxicosis in patients with pre-existing hyperthyroidism?
Yes. If someone has pre-existing UNTREATED hyperthyroidism and elderly, Methimazole should be started. The exact dose has not been proven but I use 5 mg daily for 2 months. Urinary iodine after a CT scan with contrast has been documented to be high at 2 weeks and 1 month but not 2 months post infusi...
Can carbamazepine make thyroid function test results look spuriously abnormal?
Carbamazepine can also displace thyroid hormone from binding proteins. Although in the short term this might transiently increase free T4 (with a reciprocal decrease in TSH), thyroid function tests should normalize once an equilibrium is achieved. In some assays that rely on dilution of the sample, ...
Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?
The key word in this question is "consider". GIven the lack of published clinical trials to assess efficacy (CV and CKD hard outcomes) versus safety (DKA) in this population, an answer at this time would be a qualified yes, with the qualifications being a well-motivated patient who adheres to self-g...
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...
Can the desmopressin stimulation test be used to assess for central adrenal insufficiency?
No. Normal corticotroph cells do not respond to desmopressin. This is the point of using the test to differentiate between Cushing's disease and pseudo-Cushing.
In patients with secondary adrenal insufficiency, when would you consider adding fludrocortisone to their steroid regimen?
Since the pituitary gland plays a small role in regulating aldosterone secretion, patients with secondary adrenal insufficiency should not need fludrocortisone therapy. In patients with adequate glucocorticoid replacement, other causes of low BP or elevated K should be searched for.
Would you consider hormone replacement therapy in young women with germline BRCA1 mutation and history of triple negative breast cancer who underwent bilateral mastectomy and prophylactic bilateral salpingo-oophorectomy?
There is inadequate data to clearly answer the question of safety of HRT after a diagnosis of breast cancer. A recent review by Ugras and Rahman summarized the published literature and concluded that the evidence does not suggest an increase in recurrence or death with the use of HRT in this setting...
In patients using NuvaRing for contraception, is the 1mg dexamethasone suppression test reliable to screen for cortisol excess?
NuvaRing should have minimal effect on cortisol-binding globulin (see Duijkers et al., PMID 15697102). Therefore, I think you can perform the DST. However, should it be abnormal, I would repeat it after 1 month off NuvaRing, and if it returned significantly different, you should post the info here.