Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Does your decision to start or continue Ozempic therapy in patients with diabetic retinopathy depend on the severity of the retinopathy?
Yes. The concern for use of semaglutide in patients with DR is based on results of the SUSTAIN-6 trial where patients at risk for cardiovascular disease were given 1 mg of semaglutide or placebo. While semaglutide decreased the progression of renal disease in this cohort, retinal complications were ...
How do you approach a patient with Paget’s disease of bone with elevated alkaline phosphatase and history of chronic kidney disease?
You can give Zol IV, which is clearly the optimal treatment for active Paget's. Those in the field that treat many such patients just administer this very slowly over 1-2 hours and assure good hydration concomitantly. I have treated a number of patients like this, with this scenario, without any pro...
How do you approach treatment of a patient with bilateral adrenal gland thickening & biochemical evidence of ACTH-independent hypercortisolism?
Treatment options may include removing the larger adrenal mass/hyperplasia and then assessing the HPA axis after surgery or considering medical therapy. The AVS does not have a well-established role in such patients. A nice review on this topic was recently published in Endocrine Practice (Sweeney e...
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, ...
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.