Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should patients with mild subclinical hypothyroidism (TSH < 10 mIU/L) be treated with thyroid hormone replacement to improve their lipid profile?
There is a well-known association between untreated primary hypothyroidism and hypercholesterolemia with subsequent improvement of lipid profile following thyroxine replacement. However, the link between hyperlipidemia and sub-clinical hypothyroidism is less well understood. The all-important questi...
Would you treat an isolated elevated total cholesterol in a post-menopausal patient who is otherwise healthy and has no significant CV risk factors?
This is not a simple yes or no question as asked, particularly with the limited information provided. Whether I would pharmacologically treat such a patient would depend on her actual lipid values. What are her LDL, HDL and triglyceride values? On the one hand, a total cholesterol could be elevated ...
Which patient population would benefit most from cellulose and citric acid (Plenity) therapy for weight loss?
Theoretically, this could be a treatment option for patients who do not have insurance coverage for/cannot afford GLP-1RA, and who are not candidates for alternative therapy with phentermine, qsymia, or contrave (perhaps due to high blood pressure). However, the weight loss benefit of treatment with...
What is the utility of an oral calcium loading test to differentiate FHH from secondary hyperparathyroidism due to low calcium intake?
Both vitamin D deficiency and calcium deficiency can result in secondary hyperparathyroidism. Before entertaining the diagnosis of FHH, I would treat the patient with an adequate calcium intake of 1000 mg a day of elemental calcium preferably from dietary sources like dairy. Supplemental sources are...
What is the next best anti-hypertensive medication to start after mineralocorticoid receptor antagonists in patients with primary aldosteronism?
I have had a good experience with calcium channel blockers and combined alpha/beta-blockers such as carvedilol in patients with PA. They are my first and second choices after MRA. If tolerated, pushing the MRA dose to get a PRA> 1 ng/ml/hr is important. I check for proteinuria, and if present, I add...
Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?
The very premise on which SGLT2i is supposed to work does not exist, if the patient does not have meaningful GFR; in fact most would not use/start SGLT2i once eGFR is <20-25 range. Studies have excluded patients with advanced CKD and any benefit with low GFR seems very doubtful. Zinman et al., PMID...
Should weight loss medications be used in women who are gaining excessive weight during pregnancy?
No weight loss medications are currently known to be safe during pregnancy and should be avoided even in cases of excessive weight gain. Exercise, diet, and behavioral modifications are the mainstay of treatment for weight gain/obesity in pregnancy. Bupropion/naltrexone (Contrave) as well as GLP-1RA...
Would you consider exploratory surgery in a young patient with normocalcemic hyperparathyroidism that meets one or more criteria for parathyroidectomy but has no localized pathology on advanced neck imaging?
If the patient has any complications that could be caused by primary hyperparathyroidism surgery would be appropriate done by a highly experienced parathyroid surgeon. It is not uncommon for imaging to be negative in patients with relatively mild parathyroid problems.
Is dosimetry more important than preparation (ie rhTSH versus THW) when treating thyroid cancer with radioactive iodine therapy?
Formal dosimetry to determine radiation dose is almost never done because it is so labor intensive and only can be done with THW and not rhTSH preparation with (-131 and not I-123). >99% of therapies are done based on the extent of disease and purpose, i.e., remnant ablation 30-50 mCi, adjuvant ther...
What endocrine therapy would you recommend to a premenopausal female with early stage HR+ Breast cancer who is transitioning from female to male and currently on testosterone?
There is not a lot of data, and so shared decision-making is paramount, with the following considerations: Acknowledging the limited data in this setting, how would this patient feel about stopping testosterone? While many patients feel that T is critical for identity, others may not feel that way. ...