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Thiago Mendes Profile picture
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14 Aug, 4 tweets, 2 min read
Hey #MedTwitter,

Have you ever heard of Lp(a)?🤔

It is a powerful atherosclerotic lipoprotein.

Let's go with a short Lp(a)🧵

#MedEd
Lp(a) is a type of LDL with the apo(a).

Problem 1: Lp(a) is strongly related to CVD, with increased risk at values ≥ 30 mg/dL (baseline) or ≥ 50 mg/dL (on statin).

Problem 2: Lp(a) does not respond to diet, exercise, and statin
Up to 20% of the population has ⬆️ Lp(a).

A clue to suspect: LDL does not ⬇️ as expected after statin therapy.

How to diagnose? Measuring.

What about the future? There is evidence that drugs targeting mRNA are the key, decreasing Lp(a) by up to 80%!
nejm.org/doi/full/10.10…
Looking forward to the ongoing RCT assessing MACE!!

clinicaltrials.gov/ct2/show/NCT04…

That is all folks!!

👊👊

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More from @mendesthiagob

Thiago Mendes Profile picture
15 Aug
Hey #MedTwitter,

❗️It is common to be told not to assess thyroid function in severely ill patients unless clearly indicated.

Why?🤔

Today's 🧵 is about the famous euthyroid-sick syndrome.🔎

#EndoTwitter #ICU #thyroid
Let's start with a poll.

Do you feel comfortable discussing euthyroid-sick syndrome?
How are thyroid function tests in euthyroid-sick syndrome?
Read 9 tweets
Thiago Mendes Profile picture
13 Aug
Hey #MedTwitter,

In endocrinology, the concept of "inappropriately normal" is the basis for the interpretation of several labs results.

Do you understand this concept? It is definitely one of the most important for understanding endocrine diseases.

Follow the 🧵
📢 Clinically, it means the problem is not with the hormone itself. It means the problem is with the "hormone coordinator", which may sound normal when it is actually failing to respond as it should.

Let's clarify it!
With few exceptions, hormones control their own secretion by a mechanism called "negative feedback".

Let's use an example:
- Thyroid secretes T3/T4 controlled by TSH.
- T3/T4 act in the pituitary controlling TSH secretion.
--> T3/T4 negatively impact TSH secretion
Read 7 tweets
Thiago Mendes Profile picture
16 Jul
Empagliflozin, an SGLT2 inhibitor, showed positive results for heart failure with preserved ejection fraction according to Boehringer's statement.♥️

Full results will be released in August.

Let's discuss SGLT2 inhibitors?

boehringer-ingelheim.us/press-release/…

Follow the 🧵

#MedEd #FOAMed
Sodium-glucose transport proteins (SGLT) are found both in the small intestines (SGLT1) and in the kidneys (SGLT2).

In the nephron, SGLT2 is the main responsible for the reabsorption of the filtered glucose. For this reason, its inhibition⬆️ glucosuria, decreasing hyperglycemia.
Phlorizin, a non-selective SGLT inhibitor, was isolated in the 1800s.

Why don't we use it?
- Instability;
- ⬇️ bioavailability;
- Inhibition of SGLT1, leading to ⬇️ intestinal glucose absorption and diarrhea
Read 10 tweets
Thiago Mendes Profile picture
22 May
Have you ever heard that nocturnal hypoglycemia causes rebound hyperglycemia in the morning?

This is also known as the Somogyi effect - published in 1938.

Did you know this concept has been contested in the last decades?

Follow the 🧵

#MedEd #diabetes #MedTwitter
Somogyi has claimed that hypoglycemia response (increase in glucagon, GH, cortisol, and) could overcompensate leading to hyperglycemia.

This is not true for most hormones' feedback. Let's use the thyroid to make a parallel:
When the thyroid loses function, TSH gets ⬆️. Can this high TSH overcompensate loss of thyroid function and cause hyperthyroidism? No!

What about glucose?
Read 8 tweets
Thiago Mendes Profile picture
21 May
Hey #MedTwitter,

An asymptomatic patient came to the outpatient clinic because of low TSH, high fT4/T3, and positive TRAb

Final diagnosis: Biotin supplement use🤔

Follow the 🧵

#Endotip #MedEd
Biotin supplements are commonly used and do not change thyroid function.

On the other hand, biotin often causes lab assay interference mimicking Graves' disease:

⬇️ TSH

⬆️ fT4 and T3

⬆️ TRAb
TRAb is a marker of Graves' disease, the most common cause of thyrotoxicosis/hyperthyroidism, and has a high accuracy :
- Sensitivity: ~ 97%
- Specificity: ~ 99%

📢Beware that despite high reliability, TRAb result can be falsely elevated in the setting of biotin use
Read 5 tweets
Thiago Mendes Profile picture
20 May
I was working when @Rafameed texted me "watch today's VMR when possible". As soon as I got home I did it.

What a beautiful discussion @rabihmgeha, @Sharminzi, @KirtanPatolia, and @sukritibanthiya !

Just a short pearl🧵
> 2/3 of pts with adrenal insufficiency have other autoimmune condition(s).

10% of patients with adrenal insufficiency have pernicious anemia.

Bottom line: if you see a patient with autoimmune disease and hyponatremia and hyperpigmentation, check morning cortisol.
nature.com/articles/s4157…
Read 4 tweets

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