General Primary Care&nbsp;&nbsp;&nbsp;

What workup do you recommend for patients requiring higher-than-expected levothyroxine doses for their weight?

What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?

6 Answers available

Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?

What patient factors are most important when considering who needs a broader workup for osteoporosis prior to starting therapy?

Do you routinely rule out secondary causes of osteoporosis (i.e., TSH) in all patients prior to starting therapy? If you work up all patients, what la...

In patients with MASLD, would you consider management with off-label metformin, pioglitazone (despite weight gain risk), GLP-1 RA, or simply intensify lifestyle and monitor?

If you prefer monitoring strategy, how frequently do you repeat labs and what is your referral thresholds to hepatology if you're practicing in primar...

Do 5HT4 agonists such as Metoclopramide actually lead to improvement in symptoms for patients with diabetes related gastroparesis?

How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?

In patients with iron deficiency due to history of gastric bypass or IBD, would you consider oral iron therapy if the iron deficiency anemia is mild?

The patient can otherwise tolerate intermittent oral iron therapy.

5 Answers available

For patients with Hashimoto's thyroiditis, is there a commercially available blood test for detecting abnormalities in the type 1 deiodinase enzyme in order to identify patients who would potentially benefit from T4 and T3 combination therapy?

When should metformin be stopped before surgery and when is it considered safe to resume?

What are some practical tips in distinguishing between metabolic bone disease due to chronic kidney disease and osteoporosis?

In middle-aged adults with TSH 5–10 mIU/L and no symptoms, would you start levothyroxine or monitor, and does your threshold change with cardiovascular risk factors?

As referenced in this new publication: Annals of Internal Medicine. Volume 178, Number 7. https://doi.org/10.7326/ANNALS-24-01559

How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?

How do you counsel patients with metabolic syndrome who decline statin therapy and have low coronary calcium scores regarding their long-term CVD risk?

What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

When discontinuing Denosumab after more than 2-3 years of therapy, when do you recommend giving the first dose of zoledronic acid?

Have any studies shown that testosterone replacement therapy lowers the incidence of prostate cancer in hypogonadal men, or is the evidence still largely neutral?

How do you approach individualizing A1c goals in patients with dementia?

How has the use of CGMs informed or improved your management of patients with pre diabetes or diabetes not on insulin?

How many days prior to elective major surgery do you recommend holding oral GLP 1 R agonist therapy?

4 Answers available

Would you consider the use of romosozumab in men who have failed therapy with teriparatide and sustained multiple vertebral fractures?

Romosozumab is not currently FDA approved for men.

Do you routinely prescribe vitamin D to reduce the risk of fall-related fractures in elderly patients regardless of their serum levels?

When stopping denosumab and transitioning to PO bisphosphonate, do you wait for 6 months after the last denosumab injection to start PO bisphosphonate?

What is the next best osteoporosis treatment option for patients who completed 2 years of teriparatide, but has contraindication to bisphosphosnate therapy (e.g. history of atypical femur fracture)?

Would you use a parathyroid hormone analog for treatment of osteoporosis in a patient with mildly elevated AlkPhos of unclear etiology?

Would you start romosozumab in an active smoker?

During treatment of severe osteoporosis with PTH analogs (abaloparatide), would a rise in alkaline phosphatase level >200 (in the setting of normal GGT) warrant discontinuation of medication?

There is concern for elevation in alkaline phosphatase as a precursor for bone pathology, such as an increase in risk of bone malignancy, potentially ...

How should we approach the recommendation of intermittent fasting for weight loss in patients with pre-existing cardiovascular conditions, given the observed association of increased CV mortality with eating durations of less than 8 hrs?

Chen & Zhong, AHA/ASA Journals 2024

In patients with confirmed hypercortisolism with a high/normal unsuppressed ACTH who have both a pituitary adenoma and adrenal adenoma identified on imaging, can you reliably use DHEA-S to determine the source of cortisol production?

What is the preferred first-line non-insulin agent in patients with ketosis-prone diabetes during "remission" and evidence of preserved beta cell function?

What factors would lead you to extend the duration of antithyroid drug therapy in a patient with Graves' disease who is clinically euthyroid at 12 months but has risk factors for recurrence?

Do you recommend routinely monitoring pancreatic markers such as amylase and lipase while receiving GLP1 R agonist or dual agonist therapies to determine their risk of pancreatitis?