Endocrine & Metabolic Complaints#

Approach to common endocrine and metabolic complaints in primary care. Most presentations involve symptom recognition, appropriate lab testing, and knowing when to initiate treatment versus refer to endocrinology.

Key Principles#

• Symptom overlap: Thyroid dysfunction, diabetes, and other metabolic disorders share many symptoms (fatigue, weight changes, mood changes)—lab confirmation is essential
• Medication-induced: Many drugs affect glucose, thyroid function, and weight; always review medication list
• Subclinical disease: Subclinical hypo/hyperthyroidism and prediabetes are common; management decisions require shared decision-making
• Multimorbid considerations: Metabolic conditions often cluster (metabolic syndrome); address cardiovascular risk holistically

Topics#

Thyroid#

• Hyperthyroid Symptoms — palpitations, tremor, weight loss, heat intolerance
• Hypothyroid Symptoms — fatigue, weight gain, cold intolerance, constipation

Glucose Disorders#

• Hyperglycemia Symptoms — polyuria, polydipsia, weight loss; new diabetes workup
• Hypoglycemia Symptoms — diabetic vs non-diabetic; Whipple’s triad

Weight Changes#

• Weight Gain — secondary causes; medication-induced; metabolic workup
• Weight Loss (Unintentional) — malignancy screening; hyperthyroidism; GI causes

When to Refer to Endocrinology#

• Thyroid nodules requiring FNA or suspicious ultrasound features
• Graves’ disease (for RAI or surgical planning)
• Difficult-to-control hyperthyroidism or thyroid storm history
• Type 1 diabetes (initial management and ongoing co-management)
• Complex insulin regimens or recurrent severe hypoglycemia
• Suspected secondary causes of weight change (Cushing’s, pheochromocytoma, insulinoma)
• Adrenal or pituitary disorders