Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Should bone-directed agents, such as denosumab or zoledronic acid, be given when patients are being treated with radium-223?
In ALSYMPCA, bisphosphonate use at study entry was associated with a delay in symptomatic skeletal events (Sartor, et al. Lancet Oncol 2014; 15(7) 738-46). Based on this, osteoclast-targeted agents (i.e. zoledronic acid and denosumab) should be offered to patients with mCRPC that will receive radium...
Based on the recent disease-free survival results from ABCSG-18 presented at San Antonio, do you favor the use of Denosumab in the adjuvant setting?
I'll give you the simple answer first - YES. In those receiving AI adjuvant therapy (whether postmenopasual or pre with ovarian suppression/ablation). We've struggled with how (and whether) to use bisphosphonates in the adjuvant setting. The meta-analysis found a significant improvement of similar m...
How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?
The presence of antibodies makes measuring the thyroglobulin level essentailly inaccurate. PET imaging may have a role though clear data on its utlity is limited (and it's expensive). Physical exams and Ultrasonography is the best way of monitoring the disease state from a surveillance point. For sy...
How common is hypothyroidism in postradiation head and neck cancer patients?
The incidence of postradiation hypothyroidism is hard to determine, as the literature is quite varied. This variation is due to a combination of how hypothyroidism is measured, how much of the thyroid was treated, and when patients were assessed. Recent literature suggests the incidence can approxim...
When treating patients with immune checkpoint inhibitors, do you routinely check markers of endocrinopathies such as TSH/ACTH, or only when a patient has symptoms?
There are clearly defined parameters for routine monitoring that are outlined in the NCCN guidelines. We have incorporated these into our treatment plans. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf
What is your approach to the use of denosumab in patients with metastatic breast cancer with bony involvement?
I do not extrapolate the results of OPTIMIZE-2 and CALGB 70604 to denosumab. It is a different drug and until appropriate studies are performed, there is no reason to change its dose or schedule.
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 ...