Category Archives: Endocrinology

Thyroid disease: BMJ article on NICE guidelines

This article. Salient points: Starting dose of levothyroxine in hypothyroidism If 65 yrs or older, or cardiovascular disease: 25 or 50 mcg (then titrate as needed). If <65 yrs with no history of cardiovascular disease, it’s safe to go in … Continue reading

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Glucose control in Type II diabetes

(As per BMJ module ‘Clinical pointers: Blood glucose control in Type 2 diabetes’) I’ve used sulfonylureas as second-line diabetic drugs for years on a ‘devil you know’ basis, but it now seems that’s out of date; one meta-analysis showed them … Continue reading

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Diabetes management

The alphabet mnemonic is useful for remembering all the things that need to be discussed with patients: Advice – smoking, diet, exercise, weight loss. See about referring to structured educational programmes. Blood pressure Cholesterol Diabetes control Eye checks Foot checks … Continue reading

Posted in Diabetes, Hypertension | Leave a comment

Subclinical hypothyroidism

A decent-sized meta-analysis of RCTs on the treatment of subclinical hypothyroidism (raised TSH with normal T4) has been done, and the conclusion is that treatment makes no difference to symptoms, compared to placebo. There are some caveats: Pregnant women weren’t … Continue reading

Posted in Credits 2019, Endocrinology, Thyroid | Leave a comment

Talking to people about their diabetes

Judith Handley, a health policy geek with Type I diabetes, has written an article for the ‘What your patient is thinking’ section of the BMJ, on alternatives to asking people with diabetes whether they’re well-controlled (to which she always feels … Continue reading

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When not to use HbA1c for maintenance

We’re hopefully all familiar with the list of situations in which HbA1c might give a false reading when used to diagnose diabetes (short version; any situation in which the glucose might have undergone rapid recent change), but it’s also important … Continue reading

Posted in Credits 2018, Diabetes | Leave a comment

Flozins and COPD inhalers

That’s two separate subjects, not one, whose link here is that they were both the topics of useful papers in this week’s BMJ. The first was on possible adverse effects of flozins (sodium-glucose cotransporter-2 inhibitors). The paper was a very … Continue reading

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Thyrotoxicosis – initial treatment

An article from the BMJ, with some useful tips on starting anti-thyroid drugs if necessary. Causes: Medication-related (see below) Thyroiditis (subacute, de Quervain’s, initial phase Hashimoto’s, postpartum) Grave’s Toxic multinodular goitre Solitary toxic adenoma Very rarely, functional thyroid carcinoma Medication-related … Continue reading

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Second-line drugs in diabetes

I love studies that explore the practical questions we wrestle with in day-to-day work. So, I was pleased to see the BMJ study ‘Sulfonylureas for type 2 diabetes‘ (Douros et al). The presentation of the results in the written journal … Continue reading

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Remission of diabetes?

I’ve often wondered what happens if a diabetic person actually makes significant enough lifestyle changes to bring their blood glucose down into the non-diabetic range; since diabetes is diagnosed based on glucose levels, would this mean that this person had … Continue reading

Posted in Credits 2017, Diabetes, Endocrinology | Leave a comment