Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
How do you counsel patients on timing of their medications when they are taking both oral semaglutide and levothyroxine?
I have no personal experience with the situation that you describe. However, it is well known that Levothyroxine should be taken on an empty stomach, because several foods such as high fiber meals, coffee, calcium, and iron supplements can bind to levothyroxine and significantly reduce its effective...
What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?
This is an important question to keep an eye on, given the broadening use and effectiveness of GLP-1 agonists for various conditions, especially diabetes, and for weight loss. Unfortunately, as is so often the case, major clinical trials in this area do not reflect the heterogeneity of older adults ...
Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?
Phentermine has been available since 1959 and remains an affordable and effective medication option added to a full lifestyle-based weight management plan. In people who are generally healthy and without contraindications to the medication, I have had patients used in at least intermittently for sev...
What doses of methimazole do you consider "low dose" when treating Graves' disease long-term?
"Low dose" methimazole is traditionally considered to be doses of <5-10 mg a day, but I think the definition should be 5 mg or less a day. Indeed, some patients can be controlled on 2.5 mg a day, and I have several patients with normal thyroid function who have taken 2.5 mg every other day for sever...
Under what clinical circumstances, if any, would you prescribe fenofibrate along with statin therapy?
Yes, I do sometimes combine fibrates and statins. Usually, it’s in the setting of needing to treat severe hypertriglyceridemia with the fibrate in a patient who also has hypercholesterolemia and an indication for a statin. If a patient is on a statin and still has mild to moderate hypertriglyceridem...
When stopping denosumab and transitioning to PO bisphosphonate, do you wait for 6 months after the last denosumab injection to start PO bisphosphonate?
Some background: In patients discontinuing denosumab without subsequent antiresorptive therapy, BMD rapidly reverts back to baseline with an elevation in vertebral fracture risk (with an enhanced risk of multiple vertebral fractures). Thus, sequential treatment regimens following denosumab have been...
Would you prescribe testosterone to a post-menopausal woman for low libido and/or fatigue symptoms assuming all other work up is unremarkable?
I have never prescribed testosterone to women for decreased libido, if the other workup is normal. In addition, if you explain the side effects, such as increasing hirsutism, most women opt out of taking testosterone for this purpose.
How do you counsel patients on the risk of hypothyroidism after radioactive ablation for hot nodules?
I tell my patients that the eventual likelihood of developing hypothyroidism after radioactive iodine treatment for autonomous thyroid nodules is dependent on the administered activity, but may be as high as 60%. Demir et al., PMID 35537668 Ceccarelli et al., PMID 15730415