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لما دخلت طب
@MD_DSS
منشنا شعورك واللي واجهته لما دخلت الطب وطب الاسنان..
United Kingdom Katılım Mayıs 2016
6 Takip Edilen12.6K Takipçiler
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Approach to SLE in Pregnancy (Canada-based guidelines)
For internal medicine & obstetric medicine residents
🔍 Diagnosis | 🧠 Risk | ⚠️ Flares | 🩺 Monitoring | 🧬 Treatment | 🚼 Delivery
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Approach to Rheumatoid Arthritis (RA)
📚 Based on Toronto Notes 2025 & Canadian Guidelines
🎯 For Internal Medicine residents
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NICE Guidelines (UK) for SCH in Pregnancy 🇬🇧
📌Treatment threshold is higher than ACOG/Canadian:
🔹Treat only if TSH ≥7 mIU/L, regardless of anti-TPO
🔹No treatment if TSH <7 and FT4 normal
Unless positive anti TPO
Exception: consider LT4 if history of infertility or miscarriage
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3️⃣ Approach in General Adults
📌 Based on TSH level and patient context
🔹 TSH 4.5–10 mIU/L
Observe OR treat if:
•Symptomatic
•Positive anti-TPO
•Goiter
•Infertility
•CVD or RFs
•Pregnancy planning
🔹 TSH >10 mIU/L
Treatment is generally recommended even if asymptom
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4️⃣ Whom to Treat (General Adults)
✅ Treat if:
•TSH >10
•Age <65 with symptoms
•Anti-TPO positive
•Goiter
•Infertility/subfertility
•Cardiovascular disease or risk (e.g. lipids, HTN)
⚠️ Age >65 with TSH 4.5–10: Watchful waiting is preferred unless high-risk or sympto
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7️⃣ Management in Pregnancy
✅ Treat if:
•TSH >4.0 (even if FT4 normal)
•TSH >2.5 with positive anti-TPO
•Infertility or pregnancy loss
•On ART/IUI/IVF
Goal: Keep TSH
🔹 <2.5 (1st trimester)
🔹 <3.0 (2nd/3rd)
Dose: Start 50–75 mcg/day; adjust every 4–6 weeks.
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8️⃣ Anti-TPO Positive Women
🔸 Even if TSH is <4.0, anti-TPO + women at risk for progression
🔸 Close monitoring every 4–6 weeks during pregnancy
🔸 Consider LT4 if trying to conceive or history of miscarriage
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🔟 Follow-up
•Monitor TSH every 6–8 weeks after starting or adjusting LT4
•In pregnancy: check every 4 weeks in 1st half, then 6 weeks
•Adjust doses as fetus grows or if TSH fluctuates
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Thread: Approach to Subclinical Hypothyroidism (SCH)
📚 Based on 2025 Canadian guidelines
#MedEd #InternalMedicine #Thyroid #ResidentLearning
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10. Postpartum Plan:
🍼 GDM usually resolves postpartum
🧪 Reassess with A1c or 75g OGTT at 6 weeks postpartum
🔁 Screen for T2DM every 1–3 years thereafter
✅ Encourage breastfeeding
✅ Lifestyle support to reduce future T2DM risk
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8. Pregestational DM Management:
📌 Preconception A1c goal: <6.5%
📌 Folic acid: 5 mg/day
📌 Switch to insulin (MDI or pump) early
📌 Screen for:
– Retinopathy (may worsen)
– Nephropathy (UACR/eGFR)
– Thyroid dysfunction (especially in T1DM)
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7. ⚠️ Stop Unsafe DM Meds in Pregnancy:
🚫 SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin)
🚫 DPP-4 inhibitors (e.g., sitagliptin, linagliptin)
🚫 GLP-1 RAs
🚫 ACEi, ARBs, statins
✅ Switch to insulin
✅ Consider metformin if insulin is not feasible
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5. When to Start Medications:
💉 Initiate insulin if:
•Fasting consistently >5.3
•Postprandial readings above targets
•Failed lifestyle after 1–2 weeks
•Symptomatic hyperglycemia
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4. Lifestyle First (Always):
✅ Individualized diet (low-GI carbs, 3 meals + 3 snacks)
✅ Moderate exercise (e.g., walking 15–30 mins post-meal)
✅ SMBG 4–7 times/day
✅ Refer to diabetes educator + dietitian
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3. Glycemic Targets in Pregnancy (Canada 2025):
🎯 Stricter than in non-pregnant patients:
•Fasting ≤5.3 mmol/L
•1-hour postprandial ≤7.8 mmol/L
•2-hour postprandial ≤6.7 mmol/L
•A1c <6.0% if achievable without hypoglycemia
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75g Oral Glucose Tolerance Test (OGTT) after overnight fast.
📊 GDM = any 1 of the following:
•Fasting glucose ≥5.1 mmol/L
•1-hour glucose ≥10.0 mmol/L
•2-hour glucose ≥8.5 mmol/L
Based on IADPSG/WHO — adopted in Canada.
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Diabetes in Pregnancy: A Practical Thread (Toronto Notes 2025)
For Internal Medicine Residents 🩺
Covers GDM, pregestational DM, meds, screening & postpartum care
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🔥 Must read thread by @Eb_alabdali
An on-call case where language barrier almost hid a myxedema crisis until he used AI to break through and save the patient.
Brilliant blend of clinical reasoning and tech in action.
👇👇
د.ابراهيم العبدلي@eb_alabdali
On-call in the ER: When language barrier almost hid a diagnosis… I was called to see a 45 y/o woman in the ED. No medical history on file. She had dry cough and loss of appetite. She spoke only Sinhala — and no one around could understand her. Here’s what happened next ⬇️
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