Lissa Bauer Profile picture
May 13 9 tweets 5 min read
Let's hear The Evidence For and Against Combination #Thyroid Hormone therapy by Dr. Bianco #AACE2022 #Endotwitter. This conversation is controversial here are some of the main slides
Patient's on Lt4 reporting a lot of residual symptoms in energy, cognition
Normal physiology the majority of thyroid hormone production is T4 (16:1 T4:T3) and gets converted peripherally to T3 (5mcg made in thyroid, 25mcg made peripherally)
there is a pt preference for combo therapy but most studies have not shown an improvement with combo therapy -- some think it may be b/c the right pts weren't recruited/studied
Latest study at #WalterReed by @HoangTdhdthanh showing that there may be some benefit with combo therapy in those with high residual symptoms but no benefit in those with mild/moderate symptoms
In those you do try combo therapy here are suggestions for therapy. Can consider checking T3 fasting and 2-3hrs taking dose to make sure peak is not very high
Safety data for T3? There are some retrospective studies looking at those on T3 long term and that it doesn't decrease mortality, morbidity, fractures compared to T4
In summary, it is not for everyone but there may be a subset of pts that may benefit from combo therapy.

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More from @lissabauer

May 13
Excited to hear this talk about Time-Restricted Diets by Dr. Grajower moderated by @theweightmd I'll try to share what I learned #AACE2022 #endotwitter
What are time restricted diets? We are using intermittent fasting incorrectly -- most are actually doing time restricted eating
Read 5 tweets
May 13
Now to talk about Phosphatonins and #phosphorus metabolism/bone disease by Dr. Kumar moderated by @sfeirjad...I'm ready to learn since admittedly I know little of this #AACE2022 #Endotwitter #bone Image
Why bother about phosphorus? Well it plays many roles in cellular signaling and maintenance of membrane structure of #bone. Low concentrations associated with rhabdo, decreased cardiac function and bone dysfunction (#osteomalacia, #rickets). low and high phos causes bone disease ImageImage
High Phos Concentrations are Associated with CV Disease and Excess Mortality in CRF and decreasing levels reduces CV mortality ImageImage
Read 12 tweets
May 13
Starting day 2 #AACE2022 with @ArchanaSadhu talking to us about #diabetes technologies in 2022 #endotwitter
Look how far we have come in #diabetes technology and there is still a lot more to go #AACE2022. #CGM technology has been a game changer and the accuracy continues to improve with each generation
So what's new in the pipeline for #diabetes technology? Let me tell you starting with #dexcom G7. It will be smaller with a better MARD, better warm up and ALL-IN-ONE applicator and transmitter! Just pending FDA review #AACE2022 #endotwitter #medtwitter
Read 11 tweets
May 12
The third lecture of the series of NAFLD by Dr. Cusi - Fatty liver guru -- presenting on Current and future treatments
Pioglitazone decreases visceral fat (liver fat, CV fat, muscle fat) but increases SQ fat. Effective at decreasing NASH and fibrosis
Read 8 tweets
May 12
Diagnostic tools for diagnosis of #NAFLD and complications by Dr. Lomonaco #AACE2022 #endotwitter
#NAFLD has effects on other conditions including DM, CVD, CKD etc due to increased hyperinsulinemia, insulin resistance, proinflammatory factors etc
How do we screen for #NAFLD and find the ones with fibrosis? A lot will be missed if just checking transaminases. FIB-4 and NFS is a better screening tool
Read 8 tweets
May 12
Fantastic lecture by @scottisaacsmd on the Fatty liver epidemic and introduction to the new AACE Fatty Liver Guidelines released today. First lecture by @scottisaacsmd #AACE2022 #endotwitter
NAFLD is a spectrum that includes NASH. First rule out secondary causes.
Difference between NAFL and NASH? NAFL is just the accumulation of fat w/o ballooning or much inflamation. NASH has hepatocyte changes from ballooning and inflammation. IIt is staged also based on fibrosis (F0-F4)
Read 8 tweets

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