The Endocrinologist

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Multimodal imaging of thyroid cancer

imagePurpose of review
Thyroid cancer is the most common endocrine cancer in adults with rising incidence. Challenges in imaging thyroid cancer are twofold: distinguishing thyroid cancer from benign thyroid nodules, which occur in 50% of the population over 50 years; and correct staging of thyroid cancer to facilitate appropriate radical surgery in a single session. The clinical management of thyroid cancer patients has been covered in detail by the 2015 guidelines of the American Thyroid Association (ATA). The purpose of this review is to state the principles underlying optimal multimodal imaging of thyroid cancer and aid clinicians in avoiding important pitfalls.
Recent findings
Recent additions to the literature include assessment of ultrasound-based scoring systems to improve selection of nodules for fine needle biopsy (FNB) and the evaluation of new radioactive tracers for imaging thyroid cancer.
Summary
The mainstay of diagnosing thyroid cancer is thyroid ultrasound with ultrasound-guided FNB. Contrast-enhanced computed tomography and PET with [18F]-fluorodeoxyglucose (FDG) and MRI are reserved for advanced and/or recurrent cases of differentiated thyroid cancer and anaplastic thyroid cancer, while [18F]FDOPA and [68Ga]DOTATOC are the preferred tracers for medullary thyroid cancer.

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https://journals.lww.com/co-endocrinology/Fulltext/2020/10000/Multimodal_imaging_of_thyroid_cancer.16.aspx

Alternative routes of levothyroxine administration for hypothyroidism

imagePurpose of review
The aim of the article is to present the basics of oral levothyroxine (LT4) absorption, reasons why patients may have persistently elevated serum thyroid stimulation hormone (TSH) levels, and alternative strategies for LT4 dosing.
Recent findings
Although oral LT4 tablets are most commonly used for thyroid hormone replacement in patients with hypothyroidism, case studies report that liquid oral LT4, intravenous, intramuscular, and rectal administration of LT4 can successfully treat refractory hypothyroidism.
Summary
Hypothyroidism is one of the most common endocrine disorders encountered by primary care physicians and endocrinologists. LT4 is one of the most widely prescribed medications in the world and it is the standard of care treatment for hypothyroidism. Generally, hypothyroid patients will be treated with LT4 tablets to be taken orally, and monitoring will occur with routine serum thyroid tests, including TSH concentrations. However, many patients fail to maintain serum TSH levels in the target range while managed on oral LT4 tablets. A subset of these patients would be considered to have poorly controlled hypothyroidism, sometimes termed refractory hypothyroidism. For these patients, optimization of ingestion routines and alternative formulations and routes of administration of LT4 can be considered, including oral liquid, intravenous, intramuscular, and even rectal formulations.

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https://journals.lww.com/co-endocrinology/Fulltext/2020/10000/Alternative_routes_of_levothyroxine_administration.13.aspx

Can a carnivore diet provide all essential nutrients?

imagePurpose of review
The aim of this study was to summarize current contributions affecting knowledge and predictions about the nutritional adequacy of plant-free diets, contextualized by historical accounts.
Recent findings
As demonstrated in recent experiments, nutrient interactions and metabolic effects of ketogenic diets can impact nutritional needs, sometimes resulting in nutrient-sparing effects. Other studies highlight conflicting hypotheses about the expected effect on metabolic acidosis, and therefore mineral status, of adding alkaline mineral-rich vegetables.
Summary
A carnivore diet is a newly popular, but as yet sparsely studied form of ketogenic diet in which plant foods are eliminated such that all, or almost all, nutrition derives from animal sourced foods. Ketogenic diets are already nutritionally controversial due to their near-complete absence of carbohydrate and high dietary fat content, but most ketogenic diet advocates emphasize the inclusion of plant foods. In this review, we discuss the implications of relying solely on animal sourced foods in terms of essential nutrient status.

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https://journals.lww.com/co-endocrinology/Fulltext/2020/10000/Can_a_carnivore_diet_provide_all_essential.11.aspx

Ketogenic diet as a metabolic treatment for mental illness

imagePurpose of review
Ketogenic diets, which have been used to treat drug-refractory paediatric epilepsy for over 100 years, are becoming increasingly popular for the treatment of other neurological conditions, including mental illnesses. We aim to explain how ketogenic diets can improve mental illness biopathology and review the recent clinical literature.
Recent findings
Psychiatric conditions, such as schizophrenia, depression, bipolar disorder and binge eating disorder, are neurometabolic diseases that share several common mechanistic biopathologies. These include glucose hypometabolism, neurotransmitter imbalances, oxidative stress and inflammation. There is strong evidence that ketogenic diets can address these four fundamental diseases, and now complementary clinical evidence that ketogenic diets can improve the patients’ symptoms.
Summary
It is important that researchers and clinicians are made aware of the trajectory of the evidence for the implementation of ketogenic diets in mental illnesses, as such a metabolic intervention provides not only a novel form of symptomatic treatment, but one that may be able to directly address the underlying disease mechanisms and, in so doing, also treat burdensome comorbidities (see Video, Supplementary Digital Content 1, http://links.lww.com/COE/A16, which summarizes the contents of this review).

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https://journals.lww.com/co-endocrinology/Fulltext/2020/10000/Ketogenic_diet_as_a_metabolic_treatment_for_mental.5.aspx

Low carbohydrate diet: are concerns with saturated fat, lipids, and cardiovascular disease risk justified?

imagePurpose of review
There is an extensive literature on the efficacy of the low carbohydrate diet (LCD) for weight loss, and in the improvement of markers of the insulin-resistant phenotype, including a reduction in inflammation, atherogenic dyslipidemia, hypertension, and hyperglycemia. However, critics have expressed concerns that the LCD promotes unrestricted consumption of saturated fat, which may increase low-density lipoprotein (LDL-C) levels. In theory, the diet-induced increase in LDL-C increases the risk of cardiovascular disease (CVD). The present review provides an assessment of concerns with the LCD, which have focused almost entirely on LDL-C, a poor marker of CVD risk. We discuss how critics of the LCD have ignored the literature demonstrating that the LCD improves the most reliable CVD risk factors.
Recent findings
Multiple longitudinal clinical trials in recent years have extended the duration of observations on the safety and effectiveness of the LCD to 2–3 years, and in one study on epileptics, for 10 years.
Summary
The present review integrates a historical perspective on the LCD with a critical assessment of the persistent concerns that consumption of saturated fat, in the context of an LCD, will increase risk for CVD.

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https://journals.lww.com/co-endocrinology/Fulltext/2020/10000/Low_carbohydrate_diet__are_concerns_with_saturated.8.aspx