Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
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...
Do you require levothyroxine to be taken on an empty stomach in patients with stable hypothyroidism, or is dosing with breakfast acceptable with dose adjustment?
Ideally, levothyroxine should be taken on empty stomach but if a patient is taking it with breakfast and has a stable normal TSH, it is okay to continue but if TSH fluctuates change to empty stomach.
When would you consider using transvaginal cabergoline in the treatment of prolactinoma?
This is considered an off-label use, but I have done this a few times, and I know some of my colleagues have as well. There is not much in the literature on this, mostly case reports. I would reserve this for patients who do not tolerate the oral forms of cabergoline or bromocriptine.
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
Would you favor the use of denosumab over bisphosphonate therapy for treatment of osteoporosis in patients who are at high risk for osteoarthritis given recent data suggesting reduced risk of developing knee OA?
Although the overall data to date concerning the impact of denosumab to reduce incident knee OA or lessen established disease remain limited, there are sufficient signals that warrant further investigation and support the need for an appropriately powered RCT with endpoints that include both patient...
Would you recommend RAI ablation therapy to patients with PTC who are s/p hemi-thyroidectomy and decline completion thyroidectomy despite meeting criteria based on pathology results?
RAI therapy will work to ablate the remaining thyroid lobe with about a 69% success rate using a high dose of I-131. However, extra-thyroidal tumor cells will likely not pick up I-131 with this treatment. A good reference is the 2020 meta-analysis in the Journal of Nuclear Medicine: Piccardo et al.,...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
If a patient requires more than 5 mg per day of methimazole long term do you recommend alternative treatment options such as radio-iodine ablation or surgery?
Long term use of methimazole is generally safe as long as no history of LFT elevation or abnormally low white blood cell counts. Typically, toxic multinodular goiters respond well to low dose methimazole and patients can be managed in this fashion long-term without any issues. Graves patients may re...
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...
What is the evidence, if any, for the use of low dose naltrexone in the treatment of autoimmune thyroiditis?
I do not prescribe naltrexone for thyroid disease because I have not found data to support its use. In theory, low dose naltrexone (LDN) could decrease inflammation and thus potentially block development of overt hypothyroidism in TPO positive patients. But, at this time, it is anecdotal, with no ha...