Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you use romosozumab in a patient with a cardiovascular event more than 2 years prior?
I think the cardiovascular safety data is complex. I have reviewed the data and have heard several good presentations at bone meetings. I am of the opinion that if someone has had an event such as an MI even more than two years ago, I would likely not prescribe romosozumab. We have two other anaboli...
Should patients with hypothyroidism hold their morning levothyroxine dose before going to the lab to check free T4/TSH?
There exists a lack of consensus regarding the optimal timing for thyroid blood tests in relation to levothyroxine administration. Given the 7-9 days half-life of T4 and the approximately 4-5 half-lives required for clearance from the system, the timing of levothyroxine intake doesn't significantly ...
When and for whom should we consider adding bempedoic acid to the lipid lowering regimen?
Bemepedoic acid is approved in the US for use as an adjunct to statin therapy in patients with established ASCVD (secondary prevention) or those with heterozygous Familial Hypercholesterolemia who require additional LDL- cholesterol reduction. More recently it has also been approved for primary prev...
How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?
Although this seems like a difficult situation, one must remember that in the past, patients were prepared for surgery with beta-blockers + KI, with excellent outcomes.Feek et al., PMID 6892650Therefore, I do not think you need to treat this patient with lithium, risking lithium toxicity, to prepare...
Do you give bisphosphonates after completing adjuvant anti-HER2 therapy and chemotherapy for HER2+ breast cancer to reduce the risk of recurrence?
Bisphosphonates and the RANK-ligand inhibitor, denosumab, are bone-modifying agents that are indicated to decrease the risk of bone fragility fractures in at-risk populations without cancer, and to decrease pain and complications related to metastatic bone disease. In the adjuvant setting for postme...
Do you offer adjuvant bisphosphonates to high-risk premenopausal women on ovarian suppression for early-stage breast cancer who would want to consider pregnancy in the future?
ASCO guidelines from 1/2022 recommend a discussion of bisphosphonate therapy in post-menopausal women or women on ovarian suppression who are candidates for adjuvant therapy, but risks and benefits should be carefully weighed.In a large meta-analysis of adjuvant bisphosphonate therapy in early breas...
Do you prioritize dietary modifications and exercise over early pharmacologic interventions, such as metformin or insulin, for women diagnosed with gestational diabetes?
Most women with gestational diabetes are diagnosed in their late second/ early third trimester after a standard oral glucose tolerance test. Some women may be diagnosed earlier in their pregnancy and perhaps even had undiagnosed pre-gestational diabetes. Rarely, a patient can develop type 1 diabetes...
How often should TSH levels be monitored in patients with a history of Graves' disease who are in remission with negative TSI/TBII antibodies and off medical therapy?
If Anti-thyroid drugs are discontinued when an TSH receptor antibodies are still positive, recurrent hyperthyroidism often develops within a few months. On the other hand, if the drug is discontinued when antibodies are negative (not “normal“ but still detectable), then recurrent hyperthyroidism is ...
Do you recommend adding low-dose Aspirin for primary prevention in patients with Type 2 Diabetes on Eliquis for another indication?
Most guidelines and standards of care do not generally recommend aspirin therapy for primary prevention in patients with type 2 diabetes. As such, I do not generally recommend it unless their 10-year ASCVD risk is > 20% then I would have a discussion with the patient about low-dose (81 mg) aspirin t...
Can you explain the block and replace approach in the treatment of thyrotoxicosis, including when it is most appropriate to use and how it compares to other treatment options?
More than 20 years ago, Japanese researchers had data that suggest that remission rates for Graves' disease was much better with the block and replacement treatment with Methimazole/carbimazole and Levothyroxine. At least 3 US and European studies did NOT confirm this observation. I do occasionally ...