Endo in a Bite

This episode introduces the 2025 ACE consensus framework for obesity, reframing the condition as adiposity based chronic disease (ABCD) rather than a numeric weight diagnosis. It reviews the shift toward person centered, complication centric care, emphasizing the role of both anthropometric and clinical assessment in diagnosis and staging. The discussion highlights obesity related complications as...

This episode reviews the management of dyslipidemia in special populations using an individualized, risk based framework. It emphasizes ASCVD risk assessment in older adults, patients receiving gender affirming hormone therapy, individuals living with HIV, those with chronic inflammatory or autoimmune diseases, adult survivors of childhood cancer, and solid organ transplant recipients. The discuss...

This episode reviews guideline directed statin therapy and LDL lowering strategies using ASCVD risk based statin benefit groups. It emphasizes selection of statin intensity, LDL C treatment targets, and appropriate escalation to non statin therapies, including ezetimibe, PCSK9 inhibitors, and bempedoic acid. The episode also addresses statin associated muscle symptoms, CK based management threshol...

This episode reviews the management of hypertriglyceridemia in pregnancy using a triglyceride level guided framework. It emphasizes risk stratification for maternal ASCVD versus pancreatitis, identification of secondary and genetic dyslipidemias, and implementation of lifestyle, dietary, and pharmacologic interventions with multidisciplinary oversight throughout gestation and lactation.

This episode reviews the evaluation and management of adult hypertriglyceridemia using a triglyceride level driven framework. Emphasis is placed on risk stratification to distinguish ASCVD risk reduction from pancreatitis prevention, identification and treatment of secondary and genetic contributors, and implementation of evidence based lifestyle and dietary interventions to guide therapy.

This episode breaks down hypertriglyceridemia in adults, covering classification by level, etiology, particle type, and clinical risk orientation.

This episode reviews the evaluation of adults with severe hypertriglyceridemia, according to the 2025 AACE Algorithm. • Severe Hypertriglyceridemia: Understand impaired triglyceride clearance, chylomicron accumulation, and increased pancreatitis risk, including multifactorial causes. • Familial Chylomicronemia Syndrome: Recognize this rare, early onset disorder with persistent hypertriglyceridemia...

This episode reviews how to evaluate and manage adults with extremely low or extremely high HDL cholesterol according to the 2025 AACE Algorithm. • Identifies secondary causes of abnormal HDL, such as renal disease, low estrogen states, hyperandrogenism, medications (fibrates, TZDs, niacin, anti epileptics), alcohol excess, estrogen therapy, or pesticide exposure. • Explains key genetic disorders...

This episode reviews how to evaluate and manage adults with very low LDL cholesterol (<40 mg/dL) according to the 2025 AACE Algorithm. • Identifies secondary causes such as lipid lowering therapy, malnutrition, malabsorption, and chronic diseases. • Explains key genetic disorders linked to low LDL. Including MTTP, APOB, PCSK9, ANGPTL3, and SAR1B mutations. • Summarizes diagnostic clues and next...

This episode explores the next step in the 2025 AACE Dyslipidemia Management Algorithm, focusing on adults with LDL cholesterol levels of 190 mg/dL or higher. • Discusses how to evaluate for Familial Hypercholesterolemia and rule out secondary causes. • Reviews diagnostic tools such as the Dutch Lipid Clinic Network, Simon Broome, and Welsh criteria. • Outlines a stepwise approach to assessment, g...

This episode serves as the introduction to the series on the 2025 AACE Dyslipidemia Management Algorithm, focusing on patient centered risk assessment and lifestyle based prevention strategies. • Covers ASCVD and pancreatitis risk evaluation, lifestyle modification, and shared decision making. • Introduces ASCVD risk classification, validated risk calculators, and integrated cardiometabolic manage...

In this episode, we review recommendations 73 to 84 from the 2025 American Thyroid Association guidelines on managing radioiodine refractory differentiated thyroid cancer and survivorship care. Key topics include: • Use of immunotherapy, redifferentiation therapy, and local or systemic treatments for advanced disease. • Pregnancy management, including timing of surgery, imaging considerations, and...

In this episode, we review recommendations 57 to 72 from the 2025 American Thyroid Association guidelines on the management of radioiodine avid and radioiodine refractory differentiated thyroid cancer. Key topics include: • The role of RAI therapy for iodine avid bone metastases and rising thyroglobulin levels • Criteria and management strategies for RAIR disease • Monitoring and follow up of stab...

In this episode, we review recommendations 51 to 56 from the 2025 American Thyroid Association guidelines on long term management of differentiated thyroid cancer. Key topics include: • The role of ongoing (dynamic) risk stratification in individualized patient management • Decision making for reoperative neck surgery and alternative local therapies such as ethanol and RFA • Indications for additi...

In this episode, we review recommendations 45 to 50 from the 2025 American Thyroid Association guidelines on long term management of differentiated thyroid cancer. Key topics include: • Individualization of TSH suppression strategy • Long term considerations for TSH suppression in low and intermediate risk patients • Monitoring serum thyroglobulin and Tg antibodies as markers of disease status • F...

In this episode, we break down recommendations 41 to 44 from the 2025 American Thyroid Association guidelines on differentiated thyroid cancer management. Key topics include: • Patient counseling on the small risk of second primary malignancy after RAI • Baseline labs: complete blood count and kidney function before RAI therapy • Reproductive considerations: pregnancy precautions, nursing patient...

In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surveillance and radioactive iodine management for adult patients with differentiated thyroid cancer. • Surveillance: Ultrasound as first line follow up; 6 to12 month intervals; FNA for nodes ≥10 mm; CT or PET for rising thyroglobulin without visible disease • Radioactive Iodine: Not routine in low risk...

In this episode, we break down recommendations 21 to 30 from the 2025 American Thyroid Association guidelines on differentiated thyroid cancer management. Key topics include: • Preoperative discussion of surgical risks, including nerve and parathyroid injury • Preoperative and postoperative voice assessment and laryngeal examination • Intraoperative nerve identification and monitoring strategies •...

This bonus summary episode distills the Endocrine Society’s 2025 guideline updates on primary aldosteronism into high yield pearls for clinical practice and board preparation. Key topics include: • Broad screening for hypertensive patients regardless of potassium status • Diagnostic evaluation with the aldosterone to renin ratio • Selective use of suppression testing and updated terminology • Adre...

In this episode, we review key updates from the 2025 American Thyroid Association guidelines on surgical management for adult patients with differentiated thyroid cancer. • Surgery by tumor size: lobectomy for small, low risk tumors; total thyroidectomy for larger or advanced tumors • Thyroglossal duct carcinoma: Sistrunk procedure and thyroidectomy for higher risk cases • Central and lateral neck...

In this episode, we review key updates from the 2025 ATA guidelines on surgical referral, imaging, and risk based management for adult patients with differentiated thyroid cancer. • Referral to high volume thyroid surgeons (≥25 to 50/year) for better outcomes • Comprehensive neck ultrasound; FNA for suspicious nodes ≥8 to 10 mm • Use CT or MRI if ultrasound is insufficient for invasive or bulky di...

This episode reviews the Endocrine Society’s 2025 guideline updates on managing primary aldosteronism after initial screening. • When suppression testing is indicated or unnecessary • Cortisol cosecretion in adrenal adenomas and surgical planning • Role of adrenal vein sampling (AVS) in determining laterality, with rare exceptions • Treatment strategies for unilateral vs bilateral disease • MRA th...

In this episode, we review the ATA 2025 thyroid cancer guideline updates on tumors of uncertain malignant potential and when germline genetic testing is appropriate. Topics include: • NIFTP and related tumors with strict pathologic criteria and low malignant risk • Management pearls and pitfalls of overtreatment • Indications for germline testing (PTEN, DICER1, APC, Carney complex, Werner syndrome...

This episode reviews medications and hormonal therapies that can falsely raise the Aldosterone-to-Renin Ratio (ARR), creating false-positive results in primary aldosteronism screening. • Covers centrally acting alpha-2 agonists, beta blockers, NSAIDs, and combined estrogen-progestin therapy. • Explains mechanisms for PAC and renin changes, highlighting discordance between PRA vs DRC assays. • Revi...

This episode reviews my key notes on medications and factors that can falsely lower the Aldosterone-to-Renin Ratio (ARR), leading to missed cases of primary aldosteronism. • Organized into strong, intermediate, and weak confounders for quick clinical reference. • Includes the most important non-medication factor to correct before testing: hypokalemia.