Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
What therapies do you offer patients who have osteoporosis and CKD and have had adverse reactions to several oral bisphosphonate therapies and denosumab?
Without further details as to the severity of CKD, the severity of the osteoporosis, and the specific intolerance issues with denosumab (and/or BPs), this is a very difficult question to provide specific advice. Some general comments can be offered: CKD stage 4-5 is essentially without fracture data...
In adults ≥80 years with TSH 6–10 mIU/L and minimal symptoms, do you initiate levothyroxine, monitor, or avoid treatment entirely?
I tend to check free T4 in this situation. Aging is associated with some elevation in TSH value up to 10 mIU/L with normal free T4, and in those patients, levothyroxine is not needed. In some patients, I have seen it rise above 10 with normal free T4. Supplementing levothyroxine to lower serum TSH w...
Would the diagnostic yield for ABIs or peripheral arterial duplex doppler in a patient with metal rods in both legs be similar or acceptable in comparison to those tests in a patient without metal rods?
Ankle-brachial index(ABI) relies on the compression of upper and lower extremity arteries with blood pressure cuffs and measuring the ratio of blood pressure between them. While I am not aware of specific studies in those with metallic rod fixation, ABI measurements should have similar utility as lo...
Does oral Wegovy have a worse side effect profile compared to its injectable version?
From a clinical standpoint, I would say that oral semaglutide does cause more nausea and other GI side effects than injectable semaglutide for comparable doses. I am not aware of any randomized trials looking at this question, but there are single-center retrospective studies corroborating my impres...
Is the rise in LDL and liver fat after starting tryngolza a concern?
A modest increase in LDL-C after olezarsen (Tryngolza) and plozasiran (Redemplo) have been been reported, particularly in patients with severe hypertriglyceridemia. It probably reflects the conversion of TG-rich LPs and TG-remnants to smaller lipid particles, including IDL and LDL. Notably, the non-...
What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?
I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference. What I may do in this scenario is...
Is there a role for monitoring PTH levels in patients with advanced chronic kidney disease who are receiving denosumab in order to assess for adynamic bone disease?
It is more important to monitor PTH and bone-specific alkaline phosphatase prior to the initiation of denosumab. If PTH and bone-specific alkaline phosphatase are suggestive of adynamic bone disease, I would recommend a bone biopsy to rule out adynamic bone disease prior to the initiation of denosum...
How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?
I would first determine if there are other medications the patient is on that reduce the blood glucose. Hypoglycemia with SGLT-2 inhibitors is usually due to something else. Another medication is most likely. Could be very poor dietary intake. Could lower the dose if not on the lowest available dose...
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...
Do you recommend restarting a GLP-1RA after bariatric surgery if the patient 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 ...