Clinical decision support that reasons like an endocrinologist: risk-stratify the nodule, run the DKA protocol, work up the adrenal mass, titrate the hormone — with the decision rule and exactly what would change it. Built for verified endocrinologists.
Two real endocrinology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
1.5 cm thyroid nodule, moderately suspicious on ultrasound (TI-RADS 4), euthyroid — biopsy or not?
First confirm the TSH is normal — a suppressed TSH points to a hyperfunctioning nodule that is scanned, not biopsied. With a normal TSH and a TI-RADS 4 (moderately suspicious) nodule, fine-needle aspiration is indicated at 1.5 cm; a highly suspicious TR5 would be sampled from 1 cm, and low-suspicion nodules from a larger size or not at all. Cytology (Bethesda) then guides the next step.
Decision ruleCheck TSH (low → scintigraphy, not FNA); by TI-RADS, FNA TR5 ≥1 cm, TR4 ≥1.5 cm, TR3 ≥2.5 cm; then Bethesda cytology.
Not established from this alone — the TSH, exact ultrasound features, growth and compressive symptoms change the plan.
Type-1 diabetes, glucose 480 mg/dL, pH 7.15, positive ketones, potassium 5.2, moderately dehydrated — first priorities?
Treat diabetic ketoacidosis in order: isotonic fluids first for volume, then an insulin infusion (about 0.1 U/kg/h) to close the anion gap. Watch potassium closely — start replacement once it is below about 5.2 with urine output, and hold insulin if it is under 3.3 until repleted. Add dextrose when glucose reaches around 200 so insulin can continue until the gap closes, and treat the precipitant.
Decision ruleDKA → fluids first → insulin infusion; replace K when <5.2 (hold insulin if K <3.3); add dextrose at glucose ~200; continue insulin until the gap closes; find the trigger.
Not established from this alone — the potassium, pH and gap, renal function and the precipitant change the plan.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Check the TSH first: a low TSH suggests an autonomous nodule for scintigraphy, not aspiration. Otherwise, ultrasound risk-stratifies the nodule (ACR TI-RADS or the ATA pattern), and the size threshold for fine-needle aspiration falls with rising suspicion — roughly 1 cm for highly suspicious (TR5), 1.5 cm for moderately suspicious (TR4), and 2.5 cm for mildly suspicious (TR3). Benign-pattern nodules are followed. Cytology is reported by the Bethesda system.ACR TI-RADS · ATA
Decision ruleTSH first (low → scan); TI-RADS sets the FNA size threshold (TR5 ≥1 cm, TR4 ≥1.5 cm, TR3 ≥2.5 cm); report by Bethesda.
Missing data: the TSH, the exact ultrasound features, size and growth change the threshold.
Resuscitate with isotonic fluids first, then start a fixed-rate insulin infusion to clear ketones and close the anion gap. Potassium is the safety step — replace it once it is below about 5.2 mmol/L with adequate urine output, and hold insulin if it is under 3.3 until corrected, because insulin drives potassium into cells. Add dextrose when glucose approaches 200 mg/dL so insulin continues until the gap normalizes, and treat the precipitant.ADA · DKA
Decision ruleFluids → insulin infusion → potassium (replace <5.2, hold insulin if <3.3) → dextrose at glucose ~200 → continue until gap closes; treat the trigger.
Missing data: the potassium, pH and anion gap, renal function and the precipitant drive the protocol.
Ask two questions of every incidental adrenal mass: is it functional, and is it malignant? Screen function with a 1 mg overnight dexamethasone suppression test for cortisol and plasma or urine metanephrines for pheochromocytoma, adding aldosterone-to-renin if the patient is hypertensive or hypokalemic. Judge malignancy by size and imaging phenotype — a small, lipid-rich, low-attenuation mass is a benign adenoma. Operate for a functioning tumour, a pheochromocytoma, or a large or suspicious mass.guideline synthesis
Decision ruleEvery adrenal incidentaloma → screen function (dexamethasone suppression, metanephrines, ± aldosterone/renin) and assess malignancy (size, imaging); functional/suspicious/large → surgery.
Missing data: the hormonal results, the imaging phenotype and the size change the plan.
A raised TSH with a low free T4 is overt hypothyroidism; treat with levothyroxine at roughly 1.6 µg/kg/day, starting lower in the elderly or those with cardiac disease. Recheck the TSH in six to eight weeks and adjust. Subclinical hypothyroidism (a high TSH with a normal free T4) is treated when the TSH is above about 10, or when the patient is symptomatic, pregnant or antibody-positive.ATA · guideline
Decision ruleOvert (high TSH, low free T4) → levothyroxine ~1.6 µg/kg/day, recheck TSH at 6–8 weeks; subclinical → treat if TSH >10, symptomatic, pregnant or antibody-positive.
Missing data: the free T4, antibodies, age, cardiac status and pregnancy change the dose and threshold.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist endocrinology colleague across thyroid, diabetes, adrenal, bone and pituitary — cited, non-directive, always with the decision rule.
Deep specialist agents for thyroid, diabetes & metabolism, adrenal & pituitary and bone & calcium — each its own soul and knowledge base — plus your own uploaded materials.
In the hormone axis the margin is thin. Only one of these reasons like an endocrinology colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the endocrinology build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment endocrinology opens — with your Founding Endocrinologist offer.
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It reasons in the tools you use — the TSH, TI-RADS and Bethesda, and the DKA and osteoporosis protocols — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and on the wards. Access is gated to verified physicians.
Thyroid, diabetes & metabolism, adrenal & pituitary and bone & calcium each have their own deep specialist agent on the Pro plan, on top of the full endocrinology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited endocrinology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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