Lake Endocrinology and Diabetes, PLLC

10/13/2026

I was honored with the title of being a fellow in the American College of Osteopathic Internists last week. Also honored to give a few lectures at the conference to my peers from around the country.

10/04/2026

Levothyroxine, or T4, remains the standard initial treatment for hypothyroidism. The body normally converts T4 into the active hormone T3 as needed.

Some patients continue to experience symptoms despite an appropriate TSH level. Before changing thyroid therapy, clinicians should consider other possible contributors—including anemia, sleep disorders, medication effects, mood conditions, and other medical problems.

A carefully monitored trial of combined T4/T3 therapy may be reasonable in selected patients after a thoughtful discussion of uncertain benefits and potential risks. T3 alone is generally not recommended for routine hypothyroidism treatment.

“Natural” desiccated thyroid is not automatically safer or more physiologic.

Source: American Thyroid Association
https://www.thyroid.org/thyroid-hormone-treatment/

Educational information only; never change thyroid medication without medical supervision.

09/25/2026

Denosumab (Prolia / Jubbonti) is not managed like a bisphosphonate.

Its effects reverse relatively quickly when a scheduled dose is missed or treatment is discontinued. This can cause rapid bone loss and increase the risk of vertebral fractures.

For that reason, a routine “drug holiday” is not recommended with denosumab. If treatment must be stopped, another antiresorptive medication is generally needed to reduce rebound bone loss.

The timing and choice of follow-up therapy should be planned before the next injection becomes overdue.

If you receive denosumab, keep track of your six-month dosing schedule and contact your clinician early if a dose may be delayed.

Source: Endocrine Society Clinical Practice Guideline
https://www.endocrine.org/clinical-practice-guidelines/osteoporosis-in-postmenopausal-women

Educational information only; never discontinue osteoporosis therapy without medical guidance.

A Clinical Practice Guideline update has been released, which recommend romosozumab under selective criteria as another pharmacological therapy to improve osteoporosis and reduce fracture risk in postmenopausal women.

09/18/2026

What “Low Testosterone” Actually Means

“Low T” cannot be diagnosed from fatigue or a single blood test.

Evidence-based diagnosis requires:

• Symptoms or signs consistent with testosterone deficiency
• Unequivocally low testosterone on at least two separate morning measurements
• Evaluation for the underlying cause

Sleep disorders, obesity, acute illness, medications, depression, and other conditions can produce similar symptoms—or temporarily lower testosterone.

Testosterone therapy can benefit appropriately selected men, but treatment should follow a confirmed diagnosis rather than a symptom checklist.

Have you encountered advertising that makes low testosterone seem easier to diagnose than it is?

Source: Endocrine Society Clinical Practice Guideline
https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy

Educational information only.

Recommends making a diagnosis of hypogonadism only in men with symptoms and signs consistent with testosterone (T) deficiency and unequivocally and consistently low serum T concentrations.

07/13/2026

Medicare Advantage summarized. Do your homework.

07/03/2026

Happy 4th of July!

06/18/2026

Yup

05/04/2026

I am honored to serve as the Kirksville Osteopathic Alumni Association (KOAA) president for 2026-2027. I look forward to bringing current students at my medical school and alumni closer together.

04/26/2026

I love the ones in the bottom row. Scary, but true, and I fight every day for patient’s needs and safety.

Them: "Doesn't your CGM do all that for you?"

Me: "In theory? Yes. In reality? Sometimes it needs a second opinion from a good old-fashioned finger stick."

04/04/2026

Happy Easter! Courtesy of my staff and AI 😉