Dr.GR-RahiMoon-Medical Specialist

Dr.GR-RahiMoon-Medical Specialist Dr.Ghulam Rasool RahiMoon
FCPS-Internal Medicine
CHPE(AKU)
CONSULTANT PHYSICIAN
Internal Medicine Specialist. Book your Appointment:+92 340 2392262.

Maleer Medical Center Umerkot.

SPOT Diagnosis? Write findings in X -ray Support your diagnosis?
28/05/2026

SPOT Diagnosis? Write findings in X -ray Support your diagnosis?

Graves’ Disease / Thyrotoxicosis !Initial Symptomatic Treatment:(1)-Beta-blockers Used to control adrenergic symptoms...
27/05/2026

Graves’ Disease / Thyrotoxicosis !

Initial Symptomatic Treatment:

(1)-Beta-blockers
Used to control adrenergic symptoms such as:

📍Propranolol
Typical dose:
10–40 mg orally 3–4 times daily
Severe thyrotoxicosis may require higher doses,
Propranolol also slightly reduces Peripheral conversion of T4 → T3 at higher doses.

(2)-Antithyroid Drug Therapy

📍Carbimazole
Mechanism:
Inhibits thyroid hormone synthesis by blocking thyroid Peroxidase.

Typical Starting Dose
Depends on severity:
Mild disease: 15–20 mg daily
Moderate/severe disease: 30–40 mg daily

Treatment Duration:
Usually:12–18 months.

Two strategies:

1. Titration regimen (most common in UK)
2. Block-and-replace regimen
high-dose carbimazole levothyroxine.

🚩Monitoring During Therapy:
Monitor:

TFTs every 4–6 weeks initially,
Then less frequently once stable.

TSH may remain suppressed for months early in treatment.

Important Adverse Effects of Carbimazole
👁️Common:
Rash
Pruritus
Arthralgia
GI upset

👁️Serious:
Agranulocytosis
Rare but potentially life-threatening.

Usually defined as:neutrophils

Think Clinically - Diagnose Logically!
27/05/2026

Think Clinically - Diagnose Logically!

Eid Mubarak ✨
27/05/2026

Eid Mubarak ✨

These seven terms beautifully capture the systemic slowdown of overt hypothyroidism, it is always worth noting to patien...
26/05/2026

These seven terms beautifully capture the systemic slowdown of overt hypothyroidism, it is always worth noting to patients that thyroid dysfunction is a spectrum.
In early or subclinical phases, a patient might only present with one or two of these "dwarves" (most commonly Sleepy and Draggy) before the full, classic syndromic picture develops

The primary clinical utility of the anti-GAD65 assay is distinguishing autoimmune diabetes from type 2 diabetes mellitus...
26/05/2026

The primary clinical utility of the anti-GAD65 assay is distinguishing autoimmune diabetes from type 2 diabetes mellitus (T2DM), especially when the presentation is atypical.

🚩Latent Autoimmune Diabetes in Adults (LADA): Often misdiagnosed initially as T2DM due to older age at onset (>30 years) and a gradual presentation that does not immediately require insulin.

Clinical Pearl: A positive anti-GAD65 test in a patient clinically classified as T2DM is the strongest predictor of progressive beta-cell failure and future insulin dependence. These patients typically exhibit a lower BMI, more rapid therapeutic failure on conventional oral hypoglycemic agents (OHAs), and less metabolic syndrome features.

🚩Type 1 Diabetes Mellitus (T1DM): Anti-GAD65 is present in 70% to 80% of newly diagnosed T1DM patients. Unlike other islet autoantibodies (e.g., IAA, IA-2), anti-GAD65 antibodies persist in the serum for many years after clinical onset, making them highly valuable for retrospective confirmation of autoimmune etiology.

Not a Direct Measure of beta-cell Mass: Anti-GAD65 is a qualitative marker of autoimmune targeting, not a quantitative marker of remaining islet function. To assess actual endogenous insulin production and guide immediate OHA vs. insulin decisions, it must be paired with a fasting C-peptide level and concomitant blood glucose monitoring.

💥The Autoimmune Polyendocrine Syndrome (APS) Link!

Anti-GAD65 positivity is rarely an isolated phenomenon; it serves as a reliable marker of an underlying systemic autoimmune diathesis.

🚩Thyrogastric Autoimmunity: Patients who are anti-GAD positive carry an increased relative risk for developing concurrent autoimmune thyroiditis (Hashimoto's or Graves' disease) and pernicious anemia.
🚩Clinical Pearl: The detection of anti-GAD65 warrants a baseline screening of TSH and a careful look at a complete blood count (for macrocytosis) to catch overlapping polyglandular autoimmunity early.

Best Clinical Flowchart to approach HYPERTHYROIDISM.Must read it and apply in Clinical Practice.
26/05/2026

Best Clinical Flowchart to approach HYPERTHYROIDISM.
Must read it and apply in Clinical Practice.

Become such a force in your field that your presence changes the game, and your absence leaves a void.
26/05/2026

Become such a force in your field that your presence changes the game, and your absence leaves a void.

🦋 “An ultrasound cannot confirm whether a thyroid nodule is cancer or not only a biopsy can.”Here’s the answer 😊That is ...
26/05/2026

🦋 “An ultrasound cannot confirm whether a thyroid nodule is cancer or not only a biopsy can.”

Here’s the answer 😊

That is partly true a biopsy (FNA or Fine Needle Aspiration Biopsy) is one of the main ways doctors help confirm whether a thyroid nodule is suspicious or potentially cancerous. However, a thyroid ultrasound is still very important before a biopsy

✨ Why is a thyroid ultrasound needed before a biopsy?

1. To locate the thyroid nodule accurately!
Not all thyroid nodules can be easily felt or seen from the outside. An ultrasound helps doctors see the exact location, size, shape, and depth of the nodule. Think of it as a map before collecting a sample.

2. To determine if a biopsy is actually needed!
Not all thyroid nodules require a biopsy. Some nodules appear benign (non-cancerous) on ultrasound and may only need monitoring. But if the ultrasound shows suspicious features, a biopsy may be recommended.

3. To make the biopsy more guided and accurate!
If a biopsy is needed, it is often done as an ultrasound-guided FNA biopsy to ensure the sample is taken from the correct area of the nodule. This makes the procedure more accurate and safer.

4. To check for other nodules or enlarged lymph nodes!
Sometimes only one lump is noticed, but the ultrasound may reveal additional nodules or enlarged lymph nodes that also need evaluation.

5. To create a baseline for future comparison!
Ultrasound images help doctors monitor whether the thyroid nodule grows, shrinks, or changes over time.

The usual process often looks like this:

Check-up → Thyroid Ultrasound → Lab Tests (if needed) → Biopsy/FNA (if recommended) → Treatment Plan

💜 Remember: Having a thyroid nodule does not automatically mean cancer. Many thyroid nodules are benign. That’s why proper testing and early check-ups are important to get clear answers based on medical evaluation, not fear or guesswork.

Dr.Ghulam Rasool RahiMoon
THYROID PHYSICIAN

ذيابطيس هڪ خاموش مرض آهي، پر جيڪڏهن ان جي شروعاتي علامتن کي وقت تي سڃاتو وڃي ته وڏي نقصان کان بچي سگهجي ٿو. جيڪڏهن اوهان...
26/05/2026

ذيابطيس هڪ خاموش مرض آهي، پر جيڪڏهن ان جي شروعاتي علامتن کي وقت تي سڃاتو وڃي ته وڏي نقصان کان بچي سگهجي ٿو. جيڪڏهن اوهان کي يا اوهان جي ڪنهن پياري کي گهڻي اڃ لڳڻ، گهڻي بک لڳڻ، بار بار پيشاب اچڻ (خاص ڪري رات جو)، بنا ڪنهن سبب جي وزن گهٽجڻ، هر وقت ٿڪاوٽ محسوس ٿيڻ، يا اکين اڳيان ڌنڌلوپن اچڻ جهڙيون علامتون ظاهر ٿين، ته ان کي معمولي نه سمجهو. ان کان علاوه، جسم تي ڪنهن به زخم جو دير سان ڇٽڻ پڻ شوگر جي وڌڻ جي هڪ وڏي نشاني ٿي سگهي ٿي.
اهڙي صورتحال ۾ فوري طور تي پنهنجي ويجهي ماهر طبيب سان رابطو ڪريو ۽ پنهنجو بلڊ شوگر ٽيسٽ ڪرايو، ته جيئن وقت سر علاج شروع ڪري ڪنهن به وڏي پيچيدگي کان محفوظ رهي سگهجي.

ڊاڪٽر غلام رسول-ڪنسلٽنٽ فزيشن

شوگر، جگر، ميٽابولڪ مرضن، ۽ پيٽ جي بيمارين جو ماهر

A biopsy is the ultimate truth-teller in medicine. While scans like X-rays or MRIs can spot an unusual lump or shadow, t...
26/05/2026

A biopsy is the ultimate truth-teller in medicine. While scans like X-rays or MRIs can spot an unusual lump or shadow, they can only guess what it actually is. By removing a small sample of cells and examining them under a microscope, a biopsy clears up all ambiguity—definitive confirming whether a tissue sample is benign (non-cancerous), malignant (cancerous), or affected by an infection or inflammatory disease. It turns medical guesswork into absolute certainty, ensuring you don't treat a phantom or miss a hidden threat.

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