Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Is inositol just as effective as metformin in treating insulin resistance associated with PCOS?
Myo-inositol (MYI) and its metabolite D-chiro inositol (DCI) are over-the-countersupplements that have been suggested to improve insulin action in patients with PCOS. Outside of the PCOS world, there doesn’t seem to be much traction to using MYI over metformin for pre-diabetes and I believe it is no...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What oral contraceptives pills do you favor for treatment of PCOS?
Oral contraceptives in women with PCOS are used for multiple indications, including pregnancy prevention, endometrial protection, menstrual irregularity, and cosmetic issues (hirsutism, acne, alopecia). Combination OCPs can accomplish all these goals. One concern with combination OCPs is that the pr...
How do you determine the appropriateness of starting a CGM in patients aged 75 and older with type 2 diabetes on multiple daily insulin injections?
In general, the profile of T2D on MDI is a compelling indication for CGM. The wrinkle here is "age 75 and older". Though our gut instinct is that if the base case is compelling, the case should be stronger for those aged 75 and older. Specifically, avoiding hypoglycemia is critical to keep elders we...
Would you start low dose methimazole therapy in patients with positive TRAb, normal FT4 and FT3 levels but ongoing TSH suppression in a completely asymptomatic young patient?
Yes, if TSH is <0.1, I would start Methimazole. The TRAb indicate higher risk of progressing to overt hyperthyroidism.As per European Thyroid guidelines, you can consider it, but it is at clinician's discretion: "Endogenous mild or subclinical hyperthyroidism (SH) is associated with increased risk o...
Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?
Yes, olezarsen does lower triglycerides due to other causes of hypertriglyceridemia. It is currently in trials in patients with severe hypertriglyceridemia without Familial Chylomicronemia Syndrome (FCS).
Do you consent patients for diabetes insipidus following SRS or fractionated radiation for pituitary tumors?
This, and more broadly hypopituitarism of any type, is an important consideration and likely under-addressed topic in consent.Untreated hypopituitarism in adult life is associated with reduced all-cause life expectancy, and by one study 2x mortality rate compared with age/sex matched controls. [1]Th...
Do you recommend checking both TSI and TBII antibodies for Graves' disease diagnosis and monitoring?
The two assays correlate with one another to a great degree, but they are not identical. The TRAb or TBII test measures all antibodies directed against the TSH receptor that could be stimulatory, neutral, or blocking. The TSI test only measures stimulatory antibodies, and is therefore clinically mor...
What is the likelihood of recovery of parathyroid gland function for patients who underwent total thyroidectomy, found to have embedded parathyroid glands intra-operatively and then subsequently had them re-implanted into neck muscle?
Recovery of parathyroid function after total thyroidectomy in which parathyroid tissue was found embedded in the thyroid depends upon many factors. How many glands were found in the thyroid? Was the surgery extensive, and thus perhaps led to compromise of the vascular supply of the parathyroid gland...
When interpreting a 24-hour urinary calcium, which is more accurate: 24 hour urine calcium (mg/day) or 24-hour calcium-to-creatinine ratio (mg/g)?
In my opinion, the answer is unequivocal, i.e. calcium to creatinine ratio is the only way to interpret a 24-hour urine calcium. It is essentially impossible to collect an exact urine sample of 24 hours. The only way to do this, which is often unrealistic, is for the patient to empty the bladder and...