Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
Are recurrent UTIs a contraindication to SGLT2i use?
I don't view UTIs as a contraindication to SGLT2i use, but I make a risk and benefit analysis with each patient. Bacterial UTI as well as mycotic vaginal infections may be a sign that the patient has excessive glycosuria from hyperglycemia. In general, treating hyperglycemia should lessen the freque...
How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?
Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...
In patients with low alkaline phosphatase and high Vitamin B6 levels, does negative genetic testing for ALPL mutation rule out hypophosphatasia?
In general, the answer is no. The technical details of how the genetic testing was conducted are critically important and impact the kinds of genetic variation that can be detected. Prior knowledge about the patient and prior testing in related individuals are important factors in deciding how to ch...
How do you assess and adjust treatment in patients who develops hypothyroidism after being on lithium for several years?
It depends on whether the patient is symptomatic. If not, careful monitoring is all that is needed. If there are significant symptoms, treatment with levothyroxine would be needed. Continued use of lithium is appropriate if it has been effective over time.
Do you routinely prescribe vitamin D to reduce the risk of fall-related fractures in elderly patients regardless of their serum levels?
Right now, the evidence would NOT support daily vitamin D in older adults who are not deficient just for the purposes of fall prevention. Kahwati et al., PMID 33847712However, lots get missed on fall prevention - so be sure to review all risk factors and make a personalized plan (STEADI resources ar...
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
When do you consider changing a patient's levothyroxine dose during hospitalization due to abnormal TFTs, but without clinical evidence of thyrotoxicosis or hypothyroidism?
Thank you for your question. I think this is something we commonly get in the hospital, and we often overreact to it. This was a "Things We Do For No Reason" some time back, and I think they outline the issues well.When people are acutely ill, TSH testing is unreliable. The times when TSH testing is...
Does ongoing methimazole requirement post radioactive iodine ablation therapy for toxic multinodular goiter suggest failure of therapy and need for repeat treatment or higher dose of radioactive iodine?
Radioactive iodine (RAI) ablation will have its primary effect usually within 6 months of therapy. If thyroid function tests (TFTs) are subclinically hyperthyroid with Graves' disease, I would wait up to a year, as the concomitant chronic thyroiditis may spontaneously decrease TFTs to normal. If the...
Do you offer semaglutide for weight loss management in patients with CKD?
I have prescribed semaglutide for kidney and CVD risk reduction primarily. If the patient needs weight loss management I prefer the PCP or others navigate this.
Do you start a statin concurrently with icosapent ethyl for patients with moderate hypertriglyceridemia and high ASCVD risk, or do you prefer to start a statin alone and monitor triglyceride levels?
Generally, I prefer to start one treatment at a time and so would usually start with the statin first while working on other secondary causes of hypertriglyceridemia. If follow up lipid panel shows persistent hypertriglyceridemia (in a high ASCVD risk patient), I would then consider adding icosapent...