Thyroid complaints are common—and vague. Here’s a practical, clinic-friendly way to triage symptoms, choose the right tests, and interpret results quickly.

Common Symptoms Patients Report

• Feeling of fullness in the throat, painless enlargement

• Voice changes

• Energy changes (fatigu

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A quick refresher on the thyroid axis and the most common causes of hypo- and hyperthyroidism you’ll see in clinic.

The Thyroid Axis (TRH → TSH → T4/T3)

• Hypothalamus releases TRH → stimulates the pituitary.

• Pituitary releases TSH → stimulates the thyroid to produce T4 (thyroxine) and

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Quitting is hard. Your plan doesn’t have to be. Here’s a simple, evidence-based approach that pairs combination NRT(patch + short-acting) with varenicline or bupropion when appropriate—plus dosing, side effects, and follow-up you can copy/paste into your EMR.

Why Combination NRT?

Preferred for...

Iron-deficiency anemia (IDA) is common in early childhood and often silent. Universal screening catches kids before learning and behavior are impacted.

Universal vs. Selective Screening

Universal screening is recommended.

• All children: screen once at 9–12 months.

• If a child is on iro...

 Lead can lurk in a child’s environment: homes built before 1978, some toys/jewelry, parent/caregiver jobs with lead exposure, soil (near highways/airports/industrial sites), and contaminated drinking water. Even low levels can cause brain injury, slower growth, and speech/hearing and learning probl...

Getting a Hospital Bed Covered: What to Put in Your Note (So It Doesn’t Bounce Back)

Tried getting a hospital bed approved? You know the drill: denials, “need more info,” and a dozen faxes later. The fix: front-load your documentation with the exact elements payers look for.

First: Who’s Most...

Clinical PEARLS for Prescribing Insulin (Primary Care Edition)

We’ve spent the last couple of weeks building insulin regimens. Today: practical tips, tricks, and scripts to make prescribing insulin (and supplies) painless.

1) Know Your Concentrations & Containers

• Most insulins are U-100

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You got fasting glucose under control with basal insulin…but the A1c is still high or post-meal readings are spiking. Time to layer in prandial insulin.

When to add prandial insulin

• Fasting glucose is at goal but A1c remains above target

• Clear post-meal spikes on home logs or CGM

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Are you nervous to start insulin? I was too. Insulin therapy is highly individualized, but this step-by-step will help you start confidently and safely.

When I Consider Insulin

Start insulin up front or add it when any of the following are true:

• New diagnosis with A1c ≥10%

• Severe hy...

Last week we covered adjusting Coumadin based on INR and when to consider a switch to a DOAC. This week: how to actually make the transition safely so your patient stays continuously anticoagulated.

The Goal

Maintain stable anticoagulation during the changeover while minimizing bleeding and th...