Elizabeth Pearce, M.D., has been in practice as an endocrinologist for more than 20 years. A graduate of Harvard Medical School, Pearce is a professor of medicine at Boston University School of Medicine in the section of endocrinology, diabetes and nutrition. Additionally, she is a clinical investigator and epidemiologist who has made numerous contributions to thyroid gland function and disease research.
Pearce is the former president of the American Thyroid Association (ATA). In 2011, Pearce received ATA's Van Meter Award, which recognizes outstanding contributions to thyroid research. Since 2007, Pearce has been on the Iodine Global Network leadership team, which is dedicated to the elimination of iodine deficiency disorders.
Pearce spoke with Giddy as part of an ongoing series on medical specialists.
Editor's note: This interview has been edited for length and clarity.
Pearce: After medical school, there would be three years of residency training and internal medicine, and that's typically followed by either two or three years of fellowship, which is the subspeciality training in endocrine.
Broadly speaking, endocrinologists care for patients who have disorders related to glands or hormones. That covers quite a lot of territory. Common disorders we care for are disorders of thyroid glands, such as over- and underactive thyroid, thyroid nodules and thyroid cancers.
We take care of diabetes. Some patients have diabetes that's well managed just by primary care; not everybody needs a specialist for this. Patients with more complex or harder-to-manage diabetes typically end up seeing endocrinology.
We take care of bone disorders, including the most common one, osteoporosis, and disorders of calcium, which are regulated by glands. We take care of disorders of the pituitary gland—which is a gland in the brain—and disorders of the adrenal glands.
Very common reasons are disorders of the thyroid gland, osteoporosis and diabetes.
I'm very sub-subspecialized. I'm an academic and I primarily focus on disorders of the thyroid. General endocrinologists will see any of the disorders I mentioned.
It's helpful before a first visit to come in with a list of medications. Know what you're taking. Know your own medical history and your family history so you can provide all that background information.
It's helpful to know what the clinical question is. Once in a while, I have a patient referred to my office and I'm not quite sure why they're there. Usually, there's been a referral from a primary care doctor or another physician, and it's useful to know why people are coming. If they're not sure, they should ask their referring doctor why they're going.
If they're taking any supplements, that's important to know. Since those are a little bit harder to look up and there are so many different things on the market, some of them interfere with thyroid testing or may have implications for thyroid disease. It's useful to bring those to the visit so we know what they're taking.
It depends on what disease we're looking for and what symptoms people present with. We do a lot of blood testing. For the disorders we are managing, we can understand the disease process and where the problems are with blood testing for hormone levels [and hormone imbalances]. But that's not the only thing we do, and it's going to be different for different disorders.
If someone is coming in for osteoporosis, we're going to do a bone density test, which is how that's diagnosed. If somebody is coming for thyroid nodules, most endocrinologists do their own thyroid ultrasounds, but it's going to be very disease-specific.
Endocrinology is sort of a whole-body specialty. Disorders of hormones impact all organ systems, so it's a field where we are sort of dealing with systems that could affect any part of the body depending on what the hormonal issue is.
Some initial conversations about histories, gathering data from the patient about their medical history, symptoms and family history. And then, if testing needs to be done to make a diagnosis, often that would be ordered. We often do blood testing, although not always. Very often, diagnoses hinge on getting test results.
That's impossible to answer because it really depends. Many endocrine conditions are chronic conditions. People may come back to follow up with me for their thyroid cancers for years. Or people might have a one-time problem or a question about a lab result and just need to be seen once to get that question answered. It's highly variable.
Many endocrinologists see patients with all kinds of endocrine diseases; probably most endocrinologists would see patients with all types of endocrine disorders. Sometimes in academic centers, people are very hyper-specialized. In an academic setting, you might see a doctor who really focuses primarily on thyroid or bone disease, or both. In other settings, there are people who focus primarily on diabetes or reproductive endocrine. Typically, if people are sort of more focused in their practice, often that's in an academic center.
It's going to be hugely variable depending on what they're being seen for. It's a little bit difficult to generalize. But I would say to be prepared for a visit with an endocrinologist, just knowing the details of your own history and having a sense of what the questions are that you'd like to address is helpful. For some patients, it's helpful for that initial visit to just make a list of the questions they have to make sure that everything is covered over the course of the conversation.
One medical breakthrough that would make a huge difference for patients with diabetes, particularly type 1 diabetes, would be the development of a fully automated closed-loop insulin delivery system. [Basically, it's] an "artificial pancreas," where sensors detect blood glucose levels and use them to dictate the delivery of insulin and/or other hormones to keep blood sugars in a normal range. We have seen amazing strides towards this already over the last decade.
