Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What is your experience with metformin for improving cognitive impairment in schizophrenia?
I have not found that it does much. But there was a recent promising study for using TMS on a particular brain region that is hopeful.
Do you recommend continuous glucose monitoring for patients with Type 2 diabetes who are not on insulin?
When CGM technology was first commercialized, the sensors were bulky, uncomfortable, not very accurate, expensive, and required calibration with a blood glucose meter. Now they are quite small, comfortable, much more accurate, much cheaper, and no longer require calibration. It is a matter of time b...
Would you start once-weekly tirzepatide over once daily basal insulin in a patient with Type 2 diabetes with inadequate control on oral antihyperglycemia drugs?
The issue examined in the paper cited of whether insulin or GLP-1RA is a better strategy in the setting of inadequate control of T2D was a hot question in the first part of this century but has been examined repeatedly and is now codified in global guidelines -- GLP-1RA should be used before insulin...
Do you recommend parathyroid imaging testing for patients with recurrent nephrolithiasis who are incidentally found to have an elevated PTH but who do not have hypercalciuria, hypercalcemia, hypovitaminosis D, or chronic kidney disease?
Yes, but with caveats. The “yes” is because hyperparathyroidism is a surgically curable disease if done by an experienced parathyroid surgeon. The caveat is if previous stone analyses have not shown a substantial calcium phosphate component, the stone formation may be due to other causes and unaffec...
Do you recommend obtaining a DEXA scan for patients with recurrent nephrolithiasis and hypercalciuria of unknown etiology?
I think this is an important question. I agree with Dr. @Dr. First Last. In my practice, if the patient is female, especially peri- or postmenopausal, I generally recommend a DEXA scan. If bone density is borderline or low, I typically refer the patient to an endocrinologist in our Bone Clinic for c...
What factors aside from progression do you consider most important in determining whether a patient with metastatic papillary thyroid carcinoma is radioactive iodine refractory?
RAI refractory or resistant is defined as: Progression despite adequate RAI RX within the prior year after therapy Tumor that does not take up RAI either on a diagnostic or post-therapy whole body scan
Do you recommend low dose RAI ablation for low risk papillary thyroid cancer with lymphatic invasion alone (no angio-invasion or known nodal involvement)?
No. Unless other factors, such as grossly positive margins.
What is your approach to treating subacute thyroiditis in a patient presenting with recurrent fevers?
Has ultrasound been done to rule out suppurative thyroiditis? If so, consider prednisone taper over a few weeks, particularly if painful thyroiditis and they failed a short course of NSAIDs already.
Are recurrent UTIs a contraindication to SGLT2i use?
I don't view UTIs as a contraindication to SGLT2i use, but I make a risk and benefit analysis with each patient. Bacterial UTI as well as mycotic vaginal infections may be a sign that the patient has excessive glycosuria from hyperglycemia. In general, treating hyperglycemia should lessen the freque...
What dietary modifications do you recommend for the management of type 2 diabetes, considering the benefits of Mediterranean, plant-based, low-carbohydrate, and ketogenic diets?
In general, the most important consideration for diet modifications for patients with type 2 diabetes is an individualized diet plan to which the patient can adhere and which will help the patient lose weight. Lower carb/keto diets might be associated with better weight loss in the short term, but t...