Op-Med is a collection of original articles contributed by Doximity members.
Busy with starting my new practice, I was not able to attend the AACE annual meeting this year. I feel so lucky that technology enables me to still be engaged. We have a Facebook group of endocrinologists that Dr. Jyothi Juarez started a couple of years ago, and it has been a huge boon for all of us, especially those of us just starting independent practice. We post tough cases, billing questions, sometimes rants of frustrations with insurance companies. It is great community of physicians not just helping each other out, but it is a collaboration of the greatest minds in the field coming together to deliver patients the highest level of care. I have learned so much from this group.
Dr. Juarez was smart enough to start a thread on pearls from AACE 2019 that I’m using to write this post. Not only can I share things discussed at this big conference, but I can share what physicians in the field actually found relevant from this big conference. The thread is huge, so I’m picking some things that I think will be the most relevant to the most readers.
Bone - Anabolic therapy such as teriparatide, abaloparatide, and romosozumab, was emphasized for patients with osteoporosis at high risk for fracture, particularly those with previous history of fracture, based on excellent data for reducing risk of fracture faster than antiresorptive therapy.
Anabolic therapies are injectable medications that can be used for osteoporosis for one to two years that show benefit in fracture risk. These therapies actually build bone; they do not just keep you from losing your existing bone. The most benefit is thought to be seen if they are initiated before a bisphosphonate.
Thyroid - Radioactive iodine therapy for Graves’ disease leads to worse quality of life long-term than medical or surgical management.
This is important to consider because radioactive iodine is a non-invasive way to treat Graves' disease without the risk of surgery, so as endocrinologists, we use it widely. Quality of life is so important, so understanding this may change practice habits.
There was a debunking internet myths talk that again restated things that we as endocrinologists get asked about all the time: there is no evidence to testosterone repletion in women, no evidence for use of thyroid hormone in patients with patients with normal thyroid function but positive Hashimoto’s antibodies.
This information is widely discussed and known amongst endocrinologists, so it was no surprise to this group; however, I think it is still important to share. Bioidentical hormone administration is lucrative and gaining popularity with non-endocrinology medical providers and as public interest grows, I think it is important to recognize that it is not recognized as evidence-based by the most specialized providers in this realm. Thyroid is also a hot topic right now, and I have seen a number of patients referred by providers concerned or treating for normal thyroid function in setting of positive antibodies, which is not indicated. In these patients, I recommend TSH screening once a year or if a patient develops signs or symptoms of hypothyroidism.
Weight loss drugs lorcaserin and liraglutide were considered safe in cardiovascular disease while naltrexone/buproprion and phentermine/topiramate were not recommended.
Weight loss medications are also growing in popularity and it is so important to use them safely. My opinion is that patients should be counseled extensively on nutrition and coached on healthy habit changes prior to or in adjunct to starting weight loss prescriptions. Unfortunately, this is not happening because because less than 20 percent of doctors have any training in nutrition nor do they have the time required to truly coach a patient.
There is no serotonin syndrome risk with locaserin used with usual doses of SSRI.
Lorcaserin is a weight loss medication that works on the SSRI receptor, so it is helpful to be reassured this medication can be used with an SSRI.
We need to provide more emotional support to our patients.
This is my favorite. Hello and yes! This is what makes medicine the most meaningful career there is and it has been stripped from us. We need to fight back for it. Insurance companies have destroyed the doctor-patient relationship by requiring endless paperwork and a high patient volume to keep up with ridiculously high overhead, and both doctors and patients are losing.
Arti Thangudu, MD is an endocrinologist and a 2018–2019 Doximity Author. She specializes in Endocrinology, Diabetes, and Metabolism and is a mom of two beautiful kiddos under three! She has started her own lifestyle and preventative medicine clinic called Complete Medicine in San Antonio. She has also contributed to Medscape and KevinMD. Outside of work, Dr. Thangudu enjoys traveling, cooking, and spending time with her husband and two children.
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