Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What are your preferred lipid-lowering agents and target LDL reduction goal following initiation of therapy for patients with familial hyperlipidemia without underlying CAD?
It is not easy to address this question without specifics of the 'familial hyperlipidemia," but I will give examples: Monogenic familial hypercholesterolemia - since the LDL is very high from early childhood, we tend to treat adolescents with statins with a goal of a 50% reduction (20 or 40 rosuvas...
How do you counsel patients that are positive for both stimulatory and inhibitory autoimmune thyroid markers (TRAb, TSI and TPO Ab) regarding their likelihood of flipping from hyperthyroidism to hypothyroidism?
I do not measure multiple thyroid antibodies simultaneously at the time of initial diagnosis, so this is typically not a conversation I would have at initial patient presentation. My usual practice is to check a TSI in patients with hyperthyroidism and a TPO in patients with new hypothyroidism. In p...
Would you recommend RAI ablation therapy to patients with PTC who are s/p hemi-thyroidectomy and decline completion thyroidectomy despite meeting criteria based on pathology results?
RAI therapy will work to ablate the remaining thyroid lobe with about a 69% success rate using a high dose of I-131. However, extra-thyroidal tumor cells will likely not pick up I-131 with this treatment. A good reference is the 2020 meta-analysis in the Journal of Nuclear Medicine: Piccardo et al.,...
Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?
This test indicates that this patient has fairly good urinary concentrating ability, but does not meet most criteria for "normal" since the osmoles did not go over 600. Since diabetes insipidus is a spectrum disorder, this result does not completely rule out the possibility of very mild diabetes ins...
In patients with severe osteoporosis, history of retinal artery occlusion, and hypercalciuria, would you favor PTH analogue therapy or Evenity?
Assuming that PTH and vitamin D are normal, neither. Chlorthalidone is the treatment of choice in this scenario. Chlorthalidone is usually better than HCTZ, as HCTZ often must be given BID, whereas chlorthalidone can be given daily. I have seen very large improvements in BMD with thiazide therapy, o...
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...
When should patients with diabetes mellitus be screened for osteoporosis?
Hip fracture risk is higher in patients with diabetes (T1DM almost 7 times and T2DM 38% higher than controls without diabetes) (Vestergaard, PMID 17068657), and BMD scores underestimate true risk. That has led the ADA to suggest considering treatment for bone densities with T-score <-2.0, rather tha...
How many days prior to elective major surgery do you recommend holding oral GLP 1 R agonist therapy?
Zero. Or, I suppose, if you're having surgery early in the morning, one.This has gone back and forth, but the most recent guidance from the ASA (with other societies concurring) has been that most patients can continue their GLP medications as normal preoperatively, with higher-risk people being rec...
How do you approach osteoporosis screening in men?
While osteoporosis is more prevalent in postmenopausal women, it is often under-recognized in men. The risk of mortality after hip fracture is higher in men, and that risk may extend over 10 years after injury. Men who sustain a wrist fracture are more likely to have severe osteoporosis and a higher...
How do you decide between adding oral orforglipron or starting prandial insulin in a patient with type 2 diabetes above goal on basal insulin?
This is a timely question in that it is clinically relevant, and in June 2026, the ACHIEVE-5 trial was published online in JAMA, which studied adding orforglipron to basal insulin.If the patient is judged to be significantly insulinopenic--thin, low dose of basal insulin requirement, and high postpr...