Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is it safe to use radioactive iodine therapy for patients with differentiated thyroid cancer and brain metastases?
Not all brain metastases from thyroid cancer accumulate radioactive iodine. It is not unsafe to use radioactive iodine in the presence of brain metastases, whether they have been treated with whole brain RT or SRS/SRT. If the brain metastases pick up radioactive iodine, there could be increased peri...
How long after the presentation of Graves ophthalmopathy is orbital radiotherapy helpful?
Radiation dose helps with graves disease. In the past, we have used 20 Gy in 10 fraction, but there are recent reports of using very low doses as anti inflammatory, like .2 Gy to 1 to 2 Gy total dose with good efficacy and limited or no side effects.
Can denosumab be given every 3 months?
Not without data. The long half life and persistence of bisphosphonates in the bone is different from the shorter half life of monoclonal antibodies targeting RANK ligand (32 days). So dosing denosumab 120mg every 3 months would probably lead to suboptimal drug levels and increased bone turnover. Wh...
Is there a degree of osteoporosis (based on T-score) that would prohibit you from the utilization of an AI in a strong HR+ early stage breast cancer?
Tamoxifen is often underutilized in many patients who otherwise have a narrow benefit/risk ratio from an AI. It is more preserving and more tolerated, and should be used more readily in the majority of patients with lower risk disease. Using a sequence of tamoxifen and an AI is also very reasonable ...
Do you avoid teriparatide in previously irradiated breast cancer patients with osteoporosis given the black box warning for potential risk of osteosarcoma?
Generally, teriparatide is avoided in breast cancer, previously irradiated or not, because of black box warning. Treatments for osteoporosis (based exceeding fracture thresholds with fracture risk prediction tool e.g. FRAX or Garvin) include oral bisphosphonates, IV zoledronic acid either once or tw...
Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of osteonecrosis of the jaw?
The ASCO, ADA, and Maxillofacial surgeon society guidelines on osteonecrosis of the jaw do not directly address this scenario. The antiresorptive effects of bisphosphonates persist for a long time after cessation due to a long half life in the bone. This is not the case with denosumab. Also bisphosp...
Following oral cavity radiotherapy, how do you advise patients on ongoing bisphosphonate therapy and the risk for osteonecrosis?
I asked the question, but since no one has responded, I will just comment that I have discontinued such therapy in one of my H&N patients for fear of increasing the odds of osteonecrosis occurring.
Do you regularly do bone density testing to screen for osteoporosis in men with rheumatoid arthritis without any other risk factors?
An important comorbidity in RA is fragility fractures. These patients are at higher risk of OP because of increased pro-inflammatory cytokines and glucocorticoid treatment. OP screening strategies are both feasible and effective in RA patients and recommended by most specialty organizations. Both me...
In which osteoporosis patients would you consider starting with anabolic therapy over antiresorptive therapy?
Anabolic therapies including teriparatide (PTH-analog), abaloparatide (PTHrP-analog), and romosozumab (anti-sclerostin) are all indicated for patients with osteoporosis and high fracture risk. Although denosumab (anti-RANKL) is an antiresorptive agent, it also leads to significant bone gain similar ...
When treating patients with low bone mineral density, when/how do you monitor bone turnover markers (NTX, CTX, etc)?
It is a bit difficult to answer this question without more information. If you are monitoring a patient during a drug holiday, I would order a CTX-1 and PINP when discontinuing the bisphosphonate and then again after one year. If the levels have increased over 50% from the year before that would tri...