Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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.
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...
Do you favor Sotagliflozin over SGLT2i alone for cardiovascular risk reduction in patients with Type 2 diabetes and chronic kidney disease?
The use of Sotagliflozin rather than SGLT2i alone is reasonable based on the results of the SCORED trial (Aggarwal et al., PMID 39961315). Although this trial compared sotagliflozin to placebo, rather than to SGLT2i, it did show a reduction in both MI and stroke in patients who have type 2 diabetes ...
For patients with low risk, differentiated thyroid cancer, how do you navigate the decision between less aggressive treatments, such as lobectomy alone without radioactive iodine, and more aggressive strategies?
This question is the basis of the entirety of the thyroid cancer teaching for our fellowship. I will try to answer here: Lobectomy: Generally if the tumor is low risk that is entirely within the thyroid (no extrathyroidal extension, no metastatic nodes, no aggressive history such as tall cell varia...
How does contralateral suppression of more than 50% with cosyntropin during adrenal venous sampling influence your decision to recommend adrenalectomy in patients with primary aldosteronism?
Most but not all studies support it as a secondary criterion, and ratios <1 and 0.5 compared to the periphery have been suggested. There have been rare cases where I have used it as the sole criterion where the contralateral adrenal vein could not be successfully catheterized (usually in conjunction...
What is the upper limit of blood glucose target in hyperglycemic critically ill patients?
I don't think there's much data that argues that setting the upper limit between 180 and 200 will make much of a mortality difference. The SCCM guidelines center around initiation of insulin infusions, and doesn't seem to say that we should start insulin infusions for BG>180, but tolerate it up to 2...
Does oral semaglutide provide similar cardiovascular risk reduction benefits as injectable semaglutide?
Novo Nordisk, the manufacturer of oral and injectable semaglutide, just released positive topline results in its SOUL cardiovascular outcomes trial (n=9,650) for its oral semaglutide in people with T2D and established CVD and/or CKD. The trial met the primary endpoint demonstrating a statistically s...
How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?
If physiologic concentrations of testosterone are not exceeded and the hematocrit is monitored to avoid a pathologic level of erythrocytosis, the risk for thrombosis from testosterone GAHT does not appear to in excess of the general population. I would refer you to the following two articles that pr...
What work up do you recommend for persistent subclinical hyperthyroidism with decreased RAI uptake and negative thyroid antibody tests?
If the RAIU is very low, then this may be subacute thyroiditis. Lymphocytic or silent has no biochemical confirmatory tests. If there is pain, this suggest pseudogranulomatis subacute thyroiditis associated with a high URI and a recent viral infection. The other choice is they have some nodular thyr...