Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Would you recommend getting a PET scan or an iodine whole body scan in a patient with recurrence of thyroid cancer in the neck previously treated with total thyroidectomy and 2 radioactive iodine ablations in the past?
The usual patient who has had 2 doses of I131 is not usually iodine-avid or iodine-sensitive. You will be able to determine with this information: When were the 2 doses of I-131? What did the post-therapy scan show after the last dose of I-131 and Was the tumor responsive either by Tg or tumor size...
What workup do you recommend for patients requiring higher-than-expected levothyroxine doses for their weight?
If someone is on a significantly greater than expected dose of levothyroxine for their weight, I take a careful history to confirm they are taking the medication appropriately. Usually, the issue is mistiming of medication with regards to proximity to food or supplements - or even simple nonadherenc...
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...
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...
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...
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.
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?
I am late to the responses, but I do not ever order an advanced lipid panel. Our institution does not have it on the lab menu either (one has to go to an outside lab to get it done). Anything needed for CV risk assessment can be gleaned from the history, including family history and a standard lipid...
When would you consider treating growth hormone deficiency in surgically treated acromegaly with longstanding low IGF-1 levels?
I would not treat unless there are clinical features of GHD.