A little more than a year after becoming the first and only FDA-approved therapy for the treatment of thyroid eye disease, new research is sounding the alarm on a potential risk of hearing loss seen with teprotumumab (Tepezza).

While the study contained less than 30 patients, results indicate more than 50% of patients receiving 4 infusions reported experienced hearing loss symptoms, which is much higher than the 10% of patients who developed hearing symptoms in phase 2 and 3 trials.

With approval in January 2020, teprotumumab has the potential to be a life-altering therapy in patients with thyroid eye disease. However, 10% of patients in phase 2 and phase 3 studies reported developing hearing symptoms and, according to investigators, no studies had evaluated this association using audiograms or patulous eustachain tube (PET) testing. With this in mind, a team led by Andrea Kossler, MD, of Byers Eye Institute at Stanford University, designed the current study to further explore the incidence of otologic symptoms among patients receiving the fully human monoclonal antibody inhibitor of IGF-1R in a real-world setting.

Investigators followed all patients from a single institution and questioned them about otologic symptoms before, during, and after treatment with teprotumumab. All patients reporting otologic symptoms were referred for audiogram and PET testing. For the purpose of analysis, investigators only included patients with at least 4 infusions of teprotumumab.

Check out this podcast examining trends in incidence and treatment of thyroid eye disease in 2020.

In total, investigators identified 26 patients meeting inclusion criteria. The mean age of the study cohort was 56 (30-92) years and 23 of the patients were women. Upon analyses, 65% (n=17) of patients complained of otologic symptoms. Among patients reporting symptoms, 6 reported subjective hearing loss, 7 reported new tinnitus, 6 reported an ear plugging sensation or muffled hearing, and 3 reported autophony. Investigators pointed out the development of otologic symptoms occurred after a mean of 3.6 infusions.

Further analysis indicated 4 of the 17 patients reporting otologic symptoms had new or worsening sensorineural hearing loss. Additionally, 3 patients had PET documented one PET testing and confirmed by an otolaryngologist. Overall, 2 patients had both sensorineural hearing loss and PET. However, investigators noted PET patients experienced improvement but not the resolution of symptoms after discontinuing therapy for 3 months.

Based on the results of their study, investigators urge clinicians to be cognizant of the potential for otologic symptoms among patients receiving teprotumumab for treatment of thyroid eye disease.

“Providers should consider performing a baseline audiogram with PET testing and performing audiograms with PET testing for patients that develop hearing symptoms during or after therapy. Hearing loss is a concerning adverse event and its mechanism and reversibility should be further studied,” wrote investigators.

This study, “Teprotumumab and Hearing Dysfunction,” was presented virtually as part of ENDO 2021.

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ENDO 2021

A single-center study presented at ENDO 2021 suggests more than half of the patients with thyroid eye disease patients treated with teprotumumab (Tepezza) developed otologic symptoms.

Teprotumumab Linked to Hearing Loss, Tinnitus in New Study 

Research from an analysis of the AWARD-11 study is providing insight into the effects of increased doses of dulaglutide on HbA1c control and weight loss in patients with 

, data from the post-hoc analysis helps to inform clinicians on the effect of the expand doses, which received approval in September 2020, based on baseline HbA1c categories.

With the FDA basing their approval on the results of AWARD-11, a team led by Juan Frias, MD, of the National Research Institute, sought to further evaluate the safety and efficacy of alternate doses of dulaglutide according to baseline HbA1c levels. For the purpose of analysis, HbA1c subgroups were defined as less than 8%, 8-9%, 9 to less than 10%, and 10% or greater. A mixed-effects model was used to assess change in HbA1c from baseline at weeks 36 and 52.

Results of the investigators’ analyses indicated more patients randomized to the 3 mg or 4.5 mg dose of dulaglutide achieved an HbA1c of less than 7% at 36 weeks, regardless of baseline HbA1c level. In total, more than half of the patients randomized to 4.5 mg dulaglutide in each baseline HbA1c group were able to achieve an HbA1c of less than 7%.

Additionally, investigators pointed out this apparent improvement in HbA1c control seen with 4.5 mg dose was not associated with an increase in incidence of adverse gastrointestinal events. 

For more on the impact of this post-hoc analysis of AWARD-11 analysis, 

reached out to Juan Frias, MD, medical director of the National Research Institute.

This study, “Efficacy of Dulaglutide Expanded Doses by Baseline A1C Categories: Post Hoc Analysis of AWARD-11,” was presented virtually as part of ENDO 2021.

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Juan Frias, MD, breaks down results of a post-hoc analysis of the AWARD-11 study examining expanded doses of dulaglutide according to baseline HbA1c levels.

Expanded Doses of Dulaglutide Safe, Efficacious Regardless of Baseline HbA1c

This article was originally published on 

Despite being the most common form of secondary hypertension, new research presented at ENDO 2021 suggests just 3% of high risk patients undergo screening for primary aldosteronism. 

An analysis of data from more than 11,000 patients seen in outpatient clinics from 2010-2019, results of the study indicate diagnosis occurs after onset of symptoms on most occasions, which led investigators to call for initiatives to encourage screening of primary aldosteronism in high risk patients.

"The results of our study indicate that initiatives to encourage PA screening are crucial for preventing cardiovascular and kidney disease in many patients with hypertension," said lead researcher Seda Grigoryan, MD, an internal medicine specialist at Michigan State University,

With improved screening rates offering an opportunity to improve care of patients and alleviate a significant burden on health systems, the current study was designed by Grigoryan and a team from Michigan State University and the University of Michigan.

The study was designed as a retrospective review of patients aged 18 and older with hypertension seen at university-affiliated outpatient clinics from 2010-2019 who met at least 1 of 4 screening criteria. Screening criteria included being on 3 or more anti-hypertensive medications, having hypertension before 40 years of age, having hypertension and a known adrenal mass, and having hypertension and obstructive sleep apnea. Investigators noted they excluded patients with known high-renin hypertension, renovascular hypertension, or congenital adrenal hyperplasia.

Overall, investigators identified 11,627 patients meeting at least 1 of their inclusion criteria. Upon analysis, results indicated just 3.27% were ever screened for primary aldosteronism. Compared to those who were never screened, patients screened were younger (47.5±17.8 vs 51.3±16.9; 

 <.0001), more often women (55.28% vs 45.71%; 

=.0003), had lower serum K levels (3.4±0.5 vs 3.7±0.4, 

 <.0001), and were more likely to have chronic kidney disease (29.27% vs 17.5%; 

 <.0001) and cerebrovascular accidents (9.21% vs 6.16%; 

When assessing impact of race/ethnicity on screening rates, investigators found 79.9% of those screened were White, 15.3% were Black, and 2.3% were Asian. However, investigators pointed out screening rates were higher among Asian (8.4%) and Black (6.1%) patients than White (2.8%) patients (

 <.0001). When assessing the impact of age, investigators found screening rates were similar among those regardless of whether they were young or older than 40 years of age.

Further analysis indicated screening rates were greatest among patients with adrenal nodules (35%) and were lowest among patients with hypertension and obstructive sleep apnea (2.1%).

In subgroup analyses of patients with resistant hypertension, those screened were younger (58.5±14.0 vs 68.7±12.8, 

<.0001) and more likely to be Black (20.7% vs 10.1%) than those not screened. In subgroup analyses of patients with adrenal masses, investigators found no sex, age, or race-based differences in those screened versus those not screened.

When assessing initiation of screening, investigators found screening was initiated most often by general internists (53.9%) and endocrinologists (15.8%) while rates were notably lower among nephrologists (9.5%) and cardiologists (4.2%).

This study, “Rates of Primary Aldosteronism Screening Among High-Risk Populations,” was presented virtually as part of ENDO 2021.

An analysis presented at ENDO 2021 suggests less than 5% of patients at high risk for primary aldosteronism undergo screening and most screenings occur after the onset of symptoms. 

Study Calls for Increased Screening of Primary Aldosteronism


New research suggests COVID-19 is associated with a unique form of inflammation of the thyroid gland.

Conducted by a team of investigators based in Italy, results of the ENDO 2021 study suggest 1-in-3 diagnosed with moderate to severe COVID-19 during the early outbreak in Europe was still experiencing signs of thyroid inflammation after 3 months, despite thyroid function having already normalized.

The dysfunction triggered by COVID-19 does not appear to be mediated by autoimmunity, investigators observed, and therefore warrants follow-up research in the event that patients may be at risk of permanent thyroid dysfunction.

Investigators, led by Ilaria Muller, MD, PhD, of the University of Milan, conducted a longitudinal follow-up study of patients to survive moderate to severe COVID-19 following hospitalization in acute medical units at a facility in Milan. Patients observed for this study had no history of thyroid disorders and/or treatment thereof.

Muller and colleagues assessed patients for serum thyroid function and autoantibodies, C reactive protein (CRP), full blood count (FBC), and thyroid ultrasound for every 3 months.

At the time of the ENDO 2021 presentation, 53 patients had been included in the follow-up trial. At 3 months following COVID-19 infection, all patients presented with increased median serum TSH concentrations from baseline. Serum concentrations of free-thyroxine, free0triiodothyronine, CRP, and FBC had normalized from baseline.

Negative autoantibodies to the TSH receptor were observed in all patients.

They observed atypical subacute thyroiditis in 15% of patients hospitalized for COVID-19—a significant increase from the 1% observed with such presentations in the same facility during spring 2019, prior to the pandemic.

“The atypical thyroiditis induced by COVID-19 is not associated with neck pain, affects more men than women and especially those severely ill, thus coexists with non-thyroidal illness syndrome,” investigators wrote. “Subacute thyroiditis is classically followed by subsequent occurrence of permanent thyroid dysfunction and autoimmunity, thus we have started a systematic follow-up program of these patients.”

In a statement accompanying the findings, Muller stressed the importance of continued monitoring for such uniquely affected COVID-19 patients.

“It is important to know whether SARS-CoV-2 virus has late-onset negative effects on the thyroid gland, in order to promptly diagnose, and eventually treat, the condition,” Muller said.

The study, “Early Follow-up of Atypical Thyroiditis Induced by SARS-CoV-2,” was presented at ENDO 2021.

A study from ENDO 2021 indicates moderate-to-severe COVID-19 infections are associated with atypical thyroid inflammation.

COVID-19 Could Cause Atypical Thyroid Inflammation

New research from McMaster University provides evidence that switching to a lower, maintenance dose of denosumab may be equally as effective at 

 as the standard 60 mg dose of denosumab.

An analysis of data from a real-world, prospective study presented at 

 indicates switching from denosumab 60 mg to denosumab 30 mg every 6 months did not result in decreases in BMD or increases in fractures, which led investigators to suggest it could be a treatment option in patients who have completed long-term denosumab therapy.

With the cessation of denosumab associated with an increased risk of bone remodeling, reductions in bone mineral density (BMD), and increase risk of fracture, a team led by Aliya Khan, MD, of McMaster University, sought to assess the efficacy of low dose denosumab in postmenopausal women with osteoporosis. To do so, Khan and colleagues designed their study to assess the efficacy switching from 60 mg to 30 mg denosumab every 6 months for up to 2 years in a cohort of women who had completed long-term treatment with denosumab.

For inclusion in the study, patients were required to be 50-90 years of age, have a BMD with a T-score of -2.5 or less at lumbar spine or total hip, have a BMI between 18.5-33.2, and have normal serum calcium, 24-hour calcium, creatinine, TSH, and phosphate levels. Investigators noted patients with an additional skeletal disorder, prior fragility fracture, eGFR below 15mL/min, or on oral steroids were excluded from the study.

Check out this ENDO 2021 study on prescribing practices of osteoporotic therapies among US clinicians.

In total, 127 patients were included in the study. Of these, 44 had received 60 mg denosumab for 3 years or longer and the other 83 began transitioning before completing 3 full years of therapy.

The primary endpoint was percent change in BMD at lumbar spine, total hip, femoral neck, and 1/3 radius at 12 months and 24 months. Secondary outcomes for the study were adverse effects and fracture events.

Upon analysis, results indicated patients in the study significant improvements in BMD at lumbar spine (n=55; 2.00%, 95% CI, 0.49-3.51%; 

=.01) at 12 months. However, there were no significant changes in BMD at the femoral neck, total hip, or 1/3 radial sites at 1 year.

In an analysis of patients with 3 or more years of denosumab therapy before transitioning, results pointed to significant changes in BMD at lumbar spine (4.65%; 95% CI, 2.29-7.01%; 

 <.001), femoral neck (4.87%; 95% CI, 1.46-8.28%; 

=.006), and 1/3 radial sites (4.95%; 95% CI, 0.73-9.17%, 

=.02), but noted no significant changes were seen at total hip. Investigators pointed out similar results were seen among the group of patients with less than 3 years of denosumab therapy.

Investigators also highlighted that no fracture events were observed among participants during the study.

“Switching from 60mg of denosumab to 30 mg every 6 months was not associated with reductions in BMD and may be a valuable treatment option in patients who have completed long term denosumab therapy,” wrote investigators.

Efficacy of Low Dose Denosumab in Maintaining Bone Mineral Density in Postmenopausal Women with Osteoporosis Switching From 60mg to 30mg 6 Monthly: A Real World, Prospective Observational Study

,” was presented virtually as part of ENDO 2021.

Switching from 60 mg to 30 mg denosumab every 6 months could be an option for patients who have completed long-term denosumab therapy, according to the results of a new study from McMaster University. 

Alternating Doses of Denosumab Therapy Equally as Effective, Real-World Study Finds

A once-weekly insulin injection shows promise at ENDO 2021 by demonstrating noninferiority to daily insulin degludec in its first in-human, outpatient trial.

A 32-week phase 2 trial in 399 patients with 

, results suggest patients receiving basal insulin Fc (BIF) saw a mean HbA1c improvement of 0.6% and these patients were able to achieve similar long-term blood glucose control to those receiving insulin degludec.

“These study results demonstrate that BIF has promise as a once-weekly basal insulin and could be an advancement in insulin therapy,” said Juan Frias, MD, the trial’s principal investigator and the medical director of the National Research Institute in San Diego, 

With an interest in assessing the safety and efficacy of BIF, which is a long-acting IgG Fc-fusion protein, the current study was designed to assess the novel agent against insulin degludec in a parallel arm trial in patients with diabetes previously treated with oral antidiabetic agents and basal insulin. The trial included 2 different dosing algorithms with 2 different fasting glucose targets (140 mg/dL or less and 120 mg/dL or less) compared against insulin degludec with a fasting glucose target of 100 mg/dL or less.

The 399-patient cohort had an average age of 60.2 years, a mean baseline HbA1c of 8.1%, and a mean duration of diabetes of 14.7 years. Upon analysis, investigators found both BIIF arms achieved noninferiority (margin=.4%) for the endpoint of HbA1c change from baseline to week 32. Investigators noted both BIF groups had a statistically significant smaller increase in body weight compared to insulin degludec from baseline to week 32.

Safety analyses indicated hypoglycemic events were not significantly different between the study arms. Investigators also noted treatment-related adverse events and serious adverse events were balanced across the study arms.

reached out to Frias to learn more about his perspective on data and key takeaways from the phase 2 trial for diabetes specialists.

This study, “Once Weekly Basal Insulin Fc (BIF) is Safe and Efficacious in Patients with Type 2 Diabetes Mellitus (T2DM) Previously Treated With Basal Insulin,” was presented virtually as part of ENDO 2021.

Learn more about once-weekly basal insulin Fc from Eli Lilly and Company in this interview with the lead investigator from their phase 2 trial, which was presented at ENDO 2021.

Once-Weekly Basal Insulin Fc Shows Promise in Phase 2 Trial

New research from the Kingston Health Sciences Centre at Queen’s University has produced results in favor of SGLT2 inhibitor use in patients with 

A review of literature from 9 studies, results provide clinicians with what could be the largest overview yet detailing the efficacy and safety of SGLT2 inhibitor use in diabetic kidney transplant patients.

“Our literature review offers promising results suggesting the beneficial outcomes of SGLT2 inhibitor use in diabetic kidney transplant patients. Furthermore, its use did not result in significant adverse effects or complications,” said Shirley Shuster, MD, an internal medicine resident at Queen’s University, during her 

In the last decade, knowledge surrounding the potential uses for SGLT2 inhibitors has expanded at a historic rate. With multiple agents within the class demonstrating benefits in heart failure and chronic kidney disease, Shuster and a team of colleagues sought to explore the efficacy and safety of these agents in kidney transplant patients with diabetes.

To do so, investigators designed their study as a literature review of studies assessing SGLT2 inhibitor use in patients with type 2 diabetes mellitus or new-onset diabetes after transplant (NODAT). Outcomes of interest for the analysis included changes in blood pressure, glycemic control, body weight, kidney function, proteinuria, and adverse events.

A search performed by investigators resulted in the identification of 9 articles for inclusion in their review, including 4 case series, 3 cohort studies, a case report, and a randomized clinical trial. In total, data from 144 patients was extracted from the articles. Most of the study cohort had NODAT (n=92) or type 2 diabetes mellitus (n=50).

Investigators noted the largest study was a prospective trial from Norway, which assessed empagliflozin in 44 patients. Empagliflozin (n=82) was the most commonly used SGLT2 inhibitor in the review, followed by canagliflozin (n=34), and dapagliflozin (n=28). All patients using SGLT2 inhibitors had an eGFR greater than 30 mL/min/1.73m2 and an HbA1c greater than 6.5% at baseline.

Upon analysis, investigators found SGLT2 inhibitor use in kidney transplant patients was associated with a small or non-significant reduction in blood pressure and modest improvements in glycemic control. Further analysis indicated SGLT2 inhibitor use was associated with reductions in insulin resistance and moderate-to-significant weight reductions. Investigators highlighted their review suggested SGLT2 inhibitor use did not negatively impact graft function and a single study indicated SGLT2 inhibitor use was associated with a reduction in proteinuria.

When assessing safety, investigators found urinary tract infection (n=13) was the most common adverse effect. Results of the safety analysis further supported the use of SGLT2 inhibitors in these patients. The most common adverse event in the review was urinary tract infection and investigators also pointed out there were no cases of diabetic ketoacidosis or development of new ischemic lower limb ulcerations or amputations seen with SGLT2 inhibitor use.

Based on the results of this study and previous research, Queens University will be conducting a prospective study in the future to further demonstrate the safety and efficacy of these agents in kidney transplant patients with diabetes.

“Our tertiary care center in Kingston, Ontario is launching a prospective study, which will assess the use of SGLT2 inhibitors in the kidney transplant population,” Shuster added.

Efficacy and Safety of SGLT2 Inhibitors in Diabetic Kidney Transplant Patients: Review of the Current Literature

A literature review of studies assessing SGLT2 inhibitor use in kidney transplant patients with diabetes suggests use did not impact graft function and was associated with improvements in glucose control and body weight. 

SGLT2 Inhibitor Use is Safe, Efficacious in Kidney Transplant Patients with Diabetes, Study Finds

Underlining the importance of identifying and proactively addressing racial differences in care, an 

) are at a greater risk for heart disease, diabetes, and stroke compared to White women with PCOS.

While PCOS is common, with some estimates suggesting it impacts 1-in-10 women, the Cornell University-led systematic review and meta-analysis concluded Black women with PCOS had a poorer cardiometabolic risk profile than their White counterparts, including greater levels of insulin resistance and blood pressure.

“Our findings support the need to increase public awareness about the disproportionate burden of cardiometabolic risk in young Black women with PCOS,” said Maryam Kazemi, PhD, a Postdoctoral Associate in Professor Marla Lujan's laboratory in the Division of Nutritional Sciences at Cornell University, 

. “These findings have implications for improving the sensitivity of clinical assessments in Black women to avoid underestimating cardiovascular risk in women with PCOS.”

Despite its prevalence among women, Kazemi and team noted there was little available information related to cardiometabolic and reproductive differences based on race/ethnicity. To fill this apparent knowledge gap, the current study was designed the aim of evaluating differences in cardiometabolic profiles of Black and White women with PCOS from previously published observational studies within the MEDLINE, Web of Science, and Scopus databases.

Using a search period of January 1990-September 2020, investigators identified a total of 11 studies including 2851 participants for inclusion in the current analysis. Initially, investigators identified more than 3300 articles, but after application of inclusion criteria and exclusion of duplicates, investigators identified 11 studies for inclusion in their qualitative analysis and 10 for inclusion in their meta-analysis.

Studies included in the analysis examined women between 17-50 years of age and documented cardiometabolic risk profiles of women with PCOS, including glucoregulation, lipid profiles, anthropometric data, and hypertensive status.

The primary outcome of the study was fasting glucose. Other outcomes of interest for the study included cardiovascular events, such as stroke, coronary heart disease, and heart failure, as well as all-cause and cardiovascular mortality.

From the 11 studies identified for inclusion, investigators obtained data related to 2821 women with PCOS, including 626 Black women and 2195 White women. Investigators noted none of these studies reported on cardiovascular events/mortality rate among patients examined.

Results of the investigators’ analyses indicated Black women had increased fasting insulin (6.76 [4.97-8.56] µIU/mL; I2=59.0%), HOMA-IR (HOMA-IR; 1.47 [0.86-2.08]; I2=83.2%), and systolic blood pressure (3.32 [0.34-6.30] mmHg; I2=52.0%). However, investigators noted these same models indicated Black women had compared fasting glucose and decreased triglycerides compared to White women (

Additionally, the study arms were comparable in total cholesterol, LDL-C, HDL-C, and diastolic blood pressure levels (

 for all >.06). Investigators pointed out paucity in the number of studies evaluating cardiovascular events or mortality limit conclusions that can be drawn from current data related to disparities.

"We found a disproportionate risk for health complications in Black women with PCOS in the United States, highlighting the need to fully identify and address health disparities in women with PCOS," Kazemi added.

Black Women Have a Worse Cardio-Metabolic Risk Profile Compared to White Women with Polycystic Ovary Syndrome in the United States: A Systematic Review and Meta-Analysis

A meta-analysis of nearly a dozen studies presented at ENDO 2021 suggests Black women with PCOS were at an increased cardiometabolic risk, despite having comparable fasting glucose and lower triglyceride levels. 

Black Women with PCOS at Greater Cardiometabolic Risk than White Counterparts

Results of a new randomized, crossover trial from 

 suggest a combination therapy was as effective as levothyroxine for treatment of 

, without some of the negative effects sometimes associated with levothyroxine.

A 3-arm trial comparing levothyroxine (LT4) monotherapy, desiccated thyroid extract (DTE), and levothyroxine/liothyronine (LT4/T3) combination therapy in patients with hypothyroidism, results indicate there were no significant differences in thyroid function tests or secondary outcomes based on treatment received during the study.

"There are now proven good treatment options for the more than one in 10 patients with hypothyroidism who continue to experience symptoms of fatigue, mental fogginess, weight gain and other symptoms despite taking levothyroxine," said the study's principal investigator, Thanh D. Hoang, DO, a staff endocrinologist at Walter Reed National Military Medical Center, 

Despite being widely accepted as the standard of care for most patients with hypothyroidism, some patients still report increased incidence of fatigue, mental fogginess, and weight gain with use of levothyroxine. After performing a previous study that found nearly half of the patients examined preferred use of DTE over levothyroxine, investigators designed the current study to further evaluate use of levothyroxine in hypothyroid patients based on genotypic differences of deiodinase type 2.

Overall, 75 subjects completed the 3-arm study, which compared DTE, LT4/T3 combination therapy, and levothyroxine alone. The study used a prospective, randomized, double-blind, crossover design and patients included in the study underwent allocation to 1 of the 3 study arms for 12 weeks.

The primary outcome of interest for the study was a post-treatment score on a 36-point thyroid symptom questionnaire. Secondary outcomes of interest included weight, general health questionnaire, the Beck depression inventory, Wechsler Memory testing, lipid panels, and thyroid function tests.

Upon analysis, investigators found no significant differences between the study arms on the thyroid symptom questionnaire. Additionally, no significant between-group differences were observed among secondary outcomes.

In subgroup assessments, investigators found auditory memory index and visual working memory index were greater among patients in a group defined by presence Hashimoto’s disease than those without Hashimoto’s disease. Investigators pointed out no relationship between presence of Hashimoto's disease based on genotypes or likelihood of carrying Thr92AlaD2 polymorphism.

Further analysis indicated there was no significant differences in primary or secondary outcomes based on various genotypes of deiodinase 2. Investigators also noted there was no relationship between presence of Hashimoto’s or non-Hashimoto’s based on genotypes or likelihood of carrying Thr92AlaD2 polymorphism.

Despite there being no statistically significant preference for any treatment, investigators also highlighted there were numerically more patients with Hashimoto’s preferred DTE and LT4/T3 combination therapy than levothyroxine monotherapy.

Desiccated Thyroid Extract Versus Synthetic LT4/T3 Combination Versus LT4 Monotherapy in the Treatment of Primary Hypothyroidism With Special Attention to the Thr92AlaD2 Polymorphism

A randomized, 3-arm study is giving further insight into the effects of levothyroxine monotherapy compared against a thyroid combination therapy and desiccated thyroid extract for management of hypothyroidism, particularly in patients with Thr92AlaD2 polymorphism.

Thyroid Combination Therapy Preferred Over Levothyroxine for Some Hypothyroidism Patients

While the COVID-19 pandemic has pushed health systems to the brink, this strain has also led to the discovery of some silver linings—namely, the acceptance and integration of telehealth.

Prior to the pandemic, many saw telehealth as an innovation that was years away from widespread implementation, but COVID-19 forced the rapid adoption of many new practices. Now, a study from 

 suggests endocrinology providers and patients may favor use of telemedicine as the pandemic begins to subside.

“Endocrinology clinics have significant number of patients who need long-term close follow-up for medication adjustments, symptom checks and counseling,” said lead researcher Maryam Nemati, MD, of San Joaquin General Hospital in California,

. “Our survey found most patients felt that quality of telehealth visits both via video and phone were like in-person visits, and telemedicine is less expensive and timesaving. However, our providers felt that phone visits lack a physical examination component and therefore preferred video visits to phone visits. Given these survey results, telemedicine—particularly video visits—can be incorporated as part of follow-up visits after the COVID crisis ends.”

With an interest in evaluating patient and provider satisfaction with telehealth visits, Nemati and a team of colleagues designed and administered a survey two assess benefits and limitations telehealth visits, as well as the difference in no-show rate for 6 weeks before and after telehealth visits began. Investigators administered surveys to 109 patients who took part in a telehealth visit from January 2020-May 2020.

Among the 109 patients included in the analysis, 65% indicated they would like to continue with telemedicine following the pandemic. Specifically, 42% of patients indicated they preferred video visits and 37% indicated a preference for phone calls. When assessing limitations, the most common limitation reported was connection difficulty (25%) while 37% reported no limitations at all. Additionally, 90% of patients felt all their questions or concerns were responded to using telehealth and 77% reported they believed the quality of care using telehealth was almost the same as an in-clinic visit.

Among providers surveyed, 75% indicated a willingness to continue with telemedicine following the pandemic. When assessing benefits, 50% of providers mentioned patient satisfaction and 25% reported time savings as perceived benefits of telemedicine.

When assessing limitations, 46% noted lack of physical exam and 40% mentioned technology connection as a limitation of video visits while 60% reported lack of exam as a limitation of phone visits. Additionally, 87% of providers reported the belief that quality of care via phone visits was not the same as in-clinic visits, but 75% reported the belief that the quality of a video visit was similar to that of an in-clinic visit.

Respondent responses indicate a decrease in no-show rate from 30% to 27% in the 6 weeks prior compared to the 6 weeks following the pandemic.

"Telehealth can be more efficient for both patients and providers, but there are challenges with connectivity issues, particularly for patients and community hospitals in rural areas like our hospital," Nemati said. "These issues need to be addressed, possibly through collaborations with local government and insurance companies."

Evaluating the Use of Telemedicine in Endocrinology Clinic

An analysis of patients and providers from endocrine clinics suggests many patients and providers were open to continuing with telehealth practices after the pandemic and many saw little to no limitations with the new practices. 

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