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 thresholds, and evidence based approaches to true statin intolerance with shared decision making for optimal cardiovascular risk reduction.

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 despite low fat intake.

• Dysbetalipoproteinemia (APOE E2/E2): Learn about equal elevations of TG and cholesterol, tuberous xanthomas, low Apo B, and excellent response to fibrates.

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 linked to HDL extremes, including ABCA1 (Tangier disease), LCAT (fish eye disease), APOA1 deficiency, CETP deficiency, SCARB1 deficiency, LIPC deficiency, LIPG deficiency, and APOC3 variants.

• Summarizes diagnostic clues and next steps, such as examination for corneal clouding, orange tonsils, xanthomas, neuropathy, kidney evaluation, fasting lipid profile confirmation, and targeted genetic or family screening.

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 steps, such as liver ultrasound, vitamin level assessment, and genetic or family screening.

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, genetic testing, and family screening for early prevention

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 management.

• Highlights the importance of equity, medication access, and long term adherence.

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 TSH goals.

• Long term follow up focusing on side effect monitoring, financial counseling, and psychosocial support.

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 stable or progressive RAIR metastatic DTC

• Indications for molecular testing and tissue based biomarker assessment

• Recommended systemic therapies including multikinase inhibitors (lenvatinib, sorafenib, cabozantinib)

• Targeted therapies for NTRK, RET, ALK, and BRAFV600E mutations

• Dose management, adverse event monitoring, and strategies for treatment sequencing

• The importance of tumor biopsy and next-generation sequencing to guide therapy for resistant disease

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 additional RAI therapy for cervical lymph node metastases

• The role of EBRT in unresectable locoregional recurrences

• Radioactive iodine dosing strategies and preparation methods, including dosimetry and TSH stimulation

• Management of metastatic disease with RAI, including treatment of pulmonary micrometastases and macronodular metastases

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

• Follow up protocols for low risk differentiated thyroid cancer, including when to discontinue ultrasound and biochemical monitoring

• The role of radioiodine whole body scintigraphy in follow up care

•Indications for advanced imaging with fluorodeoxyglucose PET/CT in high risk patients

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 guidance, and fertility counseling

• Adjuvant external beam radiotherapy (EBRT) for high risk cases, balancing locoregional control with potential toxicity

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; recommended for high risk and metastatic cases; role in oncocytic thyroid carcinoma still uncertain

• Preparation for RAI Therapy: Recombinant TSH preferred; TSH goal greater than 30 mIU/L; low iodine diet before treatment

• Imaging: Pre and post therapy scans are essential

• Safety: Oral and written radiation precautions for patients and families

• Adverse Effects: Salivary gland dysfunction, xerostomia, and lacrimal duct problems, with hydration and preventive dental care recommended

• Takeaway: Ultrasound and thyroglobulin trends guide surveillance, RAI therapy should be tailored to patient risk, and careful preparation along with safety measures are critical for long term management

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

• Parathyroid preservation and autotransplantation, with calcium and vitamin D supplementation

• Avoidance of routine thyroidectomy drains

• Pathology reporting beyond AJCC staging, including vascular invasion, nodal status, and histologic subtypes

• Updated 2025 risk stratification and ATA response criteria

• Postoperative thyroglobulin measurement for guiding further management

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

• Adrenal vein sampling (AVS) as the gold standard for lateralization

• Surgical vs. medical management based on disease laterality

• Mineralocorticoid receptor antagonist therapy, titration, and renin response

• Cortisol cosecretion testing and its role in surgical planning

• Individualized treatment strategies to improve cardiovascular and metabolic outcomes

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 lymph node surgery: therapeutic vs. prophylactic approaches

• General surgical principles: avoid overtreatment, preserve thyroid function, and maximize oncologic control

• Numbers to remember: tumor sizes, surgical approaches, and key risk based strategies

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 disease

• Avoid routine preoperative thyroglobulin, antibody testing, and genomic profiling unless it informs surgical planning

• Active surveillance for very low risk papillary thyroid cancers (≤1 cm, intrathyroidal)

• Percutaneous ablation as an alternative for select low risk patients

• Indications for surgery: tumor growth ≥3 mm, nodal metastases, extrathyroidal extension, or patient preference

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 therapy, titration approach, and importance of renin response