Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How should patients time the ingestion of their alendronate and levothyroxine given issues with food/drug interactions?
Since the half-life of levothyroxine is 7-10 days, you can double the dose of Levothyroxine on 1 day and then the next day take only the alendronate. There will not be a significant change in T4 levels.
What factors guide you in adjusting the dose of fludrocortisone in a patient with primary adrenal insufficiency?
Adjustment of the dose is generally based on clinical factors. Orthostatic blood pressure should be measured on each visit with normalization of blood pressure as a goal. Also electrolytes should be measured each visit to make sure potassium levels are normal and a supplement added if need it. Lower...
What is the typical timeline for remission of autoimmune hypoglycemia?
Insulin autoimmune syndrome (IAS) or Hirata disease is a rare disorder characterized by hypoglycemic episodes due to the presence of high titers of insulin autoantibodies (IAA). The disease was first described in 1970. Because of its rarity, large clinical experiences with this disorder are limited....
What work up do you recommend in post bariatric surgery patients who are slowly gaining back the weight despite no changes in diet?
Depending on which surgical procedure they had and how long ago they had it, patients may need evaluation by their surgeon. Meanwhile, I approach these patients similarly to patients who have not had surgery. I look for reasons for their weight gain such as change in diet (even if patient denies it ...
Would you do active surveillance or completion thyroidectomy in a patient with 1.6 cm tall cell PTC with posterior margin’s indeterminate and 7 mm isoechoic solid nodule on other side?
May qualify for monitoring with full disclosure to the patient (aggressive histology) and if the following histologic and clinical features are met. Reassessing the path is recommended if the report is unclear. No extrathyroidal spread or invasion No angio-invasion Clear surgical margins Pre surgi...
For patients with central hypothyroidism and a clear etiology (such as recent head irradiation), do you recommend brain imaging prior to starting thyroid hormone replacement therapy?
Levothyroxine does not cause tumor growth, and therefore you do not need to image before starting therapy. However, in general, it takes a long time for central hypothyroidism to develop after radiation, therefore in the presence of an early reduction in FT4 you must consider the possibility of the ...
In a patient with bisphosphonate induced bilateral atypical femur fractures, how would you approach timing of alternative osteoporosis treatments and surgical management?
Unfortunately, this is still a very common problem. Although the information that oral bisphosphonates should likely be limited to 5 years duration has been available for many years, my large orthopaedic practice continues to see 2-4 atypical femur fractures per month and often the patient has been ...
Which brand/preparation of levothyroxine do you recommend to treat hypothyroid patients with alpha-gal allergy?
Alpha-gal syndrome is a type of food allergy to meats. None of the generic or brand-name thyroid medication tablets contain meat. In general, in patients with food intolerances, I recommend Tirosint capsules which contain only levothyroxine and glycerol BUT the capsule is made of gelatin derived fro...
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
Unfortunately, this patient has a very poor prognosis. Due to the nature of her tumor being poorly differentiated, her disease is more likely than not to be refractory to radioiodine. If her disease in the thyroid and neck has not been addressed, external beam radiation therapy should be offered for...
What strategies do you employ for adjusting the dosage of levothyroxine in hypothyroid patients who experience significant weight loss or are initiated on GLP-1 receptor agonists?
In spite of significant weight loss, some patients may not require a dosage change for levothyroxine while others may require a dosage reduction. It is very reasonable to recheck a TSH with free T4 after a 10% weight loss to see if a dose adjustment is needed. Rapid weight loss may lead to a tempora...