Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you recommend pharmacologic treatment with levothyroxine for a patient with subclinical hypothyroidism and CAD s/p stent placement even if the TSH is less than 10mIU/L, given a described association with reduced risk for major adverse cardiovascular events with treatment?
As always, the treatment should be individualized. The treatment of subclinical hypothyroidism can be very different in younger patients compared to the elderly. According to the European Thyroid Association, initially, if the serum TSH is elevated in the range of 4 to 10 but with a normal Free T4, ...
Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?
The secondary stroke prevention trial showed that high/moderate-intensity statin therapy combined with ezetimibe and titrated to achieve LDLc <70 were equally effective (compared to goal LDLc <100). Overall, the most important determinant of risk reduction is the achieved LDLc, and so moderate inten...
Would you switch a patient with glucocorticoid induced osteoporosis to romosozumab if a patient sustained a fragility fracture 1 year into treatment with teriparatide?
This is an interesting question for which there is no evidence-based medicine. It would be important to know what bone was broken. If it was a vertebral fracture I would likely suggest a change to romosozumab because vertebral fractures are usually not traumatic and are the purest osteoporotic fract...
How soon after radioactive iodine therapy for hyperthyroidism should Methimazole be resumed?
In patients pretreated with methimazole, there is a risk of recurrent hyperthyroidism following radioiodine (RAI) administration, with possible adverse cardiac effects, especially in older persons or in those with cardiac disease (reviewed in Walter et al., PMID 17309884). However, resumption of met...
What is the utility of checking reverse T3 in clinical practice?
I have never routinely ordered it, only when forced to by certain rare patients who are reading Dr. Google or other information they find. They think it will change their plan, it never does.
In a patient with low-risk papillary thyroid carcinoma in 1 thyroid lobe s/p hemithyroidectomy, how would a diagnosis of Graves' orbitopathy (euthyroid biochemically) affect your classification and TSH target for thyroid-cancer treatment?
Clinical information that would be useful include age, size of the tumor, tumor histology, presence or absence of ETE, angioinvasion, molecular marker profile (if performed) and lymph node status. Also important would be TSI and TRAB status. Directions and thoughts regarding optimal TSH level If ...
How do you approach insulin adjustments for a patient with type 1 diabetes who is not on an insulin pump and who has higher blood glucose levels in the late luteal phase of the menstrual cycle, when glucose levels are expected to rise?
More data is needed to answer this question. We need to know the insulin schedule that the patient is on. The basal dose of the long-acting insulin and the dose of short-acting insulin used for meals, including the insulin-to-carb ratio. We also need to know the information from the previous three o...
Do you typically adjust pump settings for patients with diabetes who are on automated insulin pumps and fasting all day for religious reasons such as Ramadan?
I would decrease basal rate to 80% if well controlled but if not, continue the same.
Does injectable semaglutide have a higher glucose-lowering efficiency than oral semaglutide?
There is a modestly lower average exposure from 14 mg of oral semaglutide than from 1 mg of injected semaglutide. But, the important issue is that the absorption of semaglutide from the stomach is exquisitely dependent on how it is administered, and probably that is the driver of greater variability...
How would you manage new onset amenorrhea, diabetes insipidus and growth hormone deficiency without other pituitary deficiencies or excess in young females with MRI findings of pituitary mass and hypothalamic edema?
Impossible to say without seeing the images. I would however image her chest in search of sarcoidosis and obtain a skeletal survey as 2/3 of patients with LCH have bone lytic lesion. Would also consider LP to measure germ cell tumor markers and to search for possible evidence of lymphoma. DI is most...