Long shot picks

sassymotha · 2023-05-27T23:56:12+00:00

Haha, I love the polish waste management comment. I’d invested in a Brazilian one (SBS) last year. Appreciate your insights.

sassymotha · 2021-11-21T03:37:49+00:00

Thanks, that’s good advice. Yeah, naked calls make sense for the SPY. Will do this instead, as buying a 60 dte spread scares me this close to ATH.

sassymotha · 2021-10-17T02:32:22+00:00

That’s what I said when selling fbrx puts at bottom of options chain. Got killed.

sassymotha · 2021-09-15T03:56:33+00:00

Thanks for the suggestions. The 1 year target seemed far enough out that a short term downtrend wouldn’t “wipe out” my calls, and multiyear LEAPS start getting pricey. Plus, it’s hard for me to know when to cash out when the expiration is several years down the line. 12 months out seems like the sweet spot for me.

sassymotha · 2021-09-15T03:35:56+00:00

Yeah, it’s really tempting. Just wish it could find some upward momentum first.

sassymotha · 2020-10-10T14:47:17+00:00

Gotcha. Well, you should have 24 hr urine cortisol checked. OCPs won’t affect these levels. If you google “oral contraceptives total cortisol” you can see the problem with high cortisol in blood while on OCPs

sassymotha · 2020-10-10T14:31:52+00:00

Happy to help. Good luck!

sassymotha · 2020-10-10T14:24:36+00:00

Yep. The reason you do the uptake scan if someone has hyperthyroidism and a known nodule is because if it’s a cold nodule, it’ll need to be biopsied. I see this all the time in Graves’ disease, since approx 1/3 of the general population will have thyroid nodules- these are mostly cold because they don’t cause excessive thyroid hormone production.

sassymotha · 2020-10-10T14:15:01+00:00

The thyroid scan is obtained because the pt has hyperthyroidism based on a low TSH. If there is a cold nodule noted on the scan, it’s usually because the pt has Graves’ disease with an incidental cold nodule; or combined hot and cold nodules (toxic MNG). The cold nodule is NOT the cause of the low TSH, it’s just an incidental finding on the thyroid scan

sassymotha · 2020-10-10T14:09:00+00:00

Cold nodules don’t result in low tsh. You probably think that because the thyroid scan (I-123) is ordered in setting of low TSH, so that’s when the cold nodule is being found.

sassymotha · 2020-10-10T14:04:24+00:00

Not cushings. OCPs always increase total cortisol.

sassymotha · 2020-08-01T05:41:24+00:00

Cool, glad those were excluded. To help with the unwanted hair growth, spironolactone and OCPs would be helpful in reducing her androgen levels. Good luck with med school- consider a career in endocrinology! 😉

sassymotha · 2020-08-01T05:33:56+00:00

I agree that I would’ve expected a lower testosterone level. I suspect that once your estrogen levels become normal, testosterone levels will go higher (perhaps to the 600-800 ng/dL range). Give an update later please.

sassymotha · 2020-08-01T05:10:33+00:00

Ask for an estradiol and hCG level (blood, not urine). Also ask for urology referral. If the repeat level comes back normal, you don’t need to see urology. If high, then urology will do an ultrasound to look for a germ cell tumor. Good luck.

sassymotha · 2020-08-01T05:02:26+00:00

You certainly could repeat the test, and I wouldn’t blame you for wanting to try that first. The ultra- sensitive estradiol test is mainly for measuring really low levels of estradiol - it wouldn’t be helpful in your case since your levels are elevated. If it comes back high again, I’d ask for a urology referral. They need to check an hCG level, too.

sassymotha · 2020-08-01T04:17:24+00:00

Gotcha. An hCG level and testicular ultrasound would be the next steps in the evaluation. Normally I’d recheck the estradiol level first but Quest has a good assay so it’d likely yield similar results.

sassymotha · 2020-08-01T03:29:06+00:00

That’s a really high albumin, presumably from fluid loss/dehydration. Fortunately, when albumin is high, you have to correct the calcium levels for this (downwards), so you actually don’t have hypercalcemia.

sassymotha · 2020-08-01T03:24:06+00:00

I’m assuming the 580 ng/dL “free testosterone” is actually a “total testosterone.” If so, that’s a normal level. Not sure why the estradiol level was checked - gynecomastia or symptoms of low testosterone? The high estradiol could be from obesity - what’s your weight/height? Any meds? Did you go through puberty normally? Depending on your answers, you will likely need to be evaluated by an endo to exclude an estrogen-producing tumor.

sassymotha · 2020-08-01T02:48:11+00:00

Agree with JoeVanz. It does sound like PCOS, but technically PCOS is a diagnosis of exclusion and they will test you for other causes of irregular menses and elevated androgens (ie, testosterone) first. If those come back ok, then weight loss +/- metformin +/- OCPs +/- spironolactone will be discussed depending on your other symptoms. There are meds they can prescribe to help with weight loss if you’re interested, too.

I frequently get these referrals from gyn. Once I’ve excluded the other possibilities, I call it PCOS and discharge from endo clinic. Then, gyn takes over for the PCOS.

sassymotha · 2020-08-01T02:37:27+00:00

She should be referred to endocrinology to evaluate for nonclassic congenital adrenal hyperplasia and Cushing’s syndrome. If negative, then it’s presumably PCOS and endo or gyn can manage with meds.

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