expert type icon EXPERT

Dr. Tseghai Berhe, MD

Endocronologist (Pediatric)

Dr. Tseghai Berhe is a pediatric endocrinologist practicing in Hoffman Estates, IL. Dr. Berhe specializes in growth, puberty, diabetes or other disorders related to hormones that produce certain conditions in children and growing young adults. Pediatric endocrinologists possess copious knowledge on hormone chemicals and how they can affect other parts of the body and their functions.
Dr. Tseghai Berhe, MD
  • Hoffman Estates, IL
  • Spartan Health Sciences University, School of Medicine,Vieux Fort, Saint Lucia
  • Accepting new patients

What are the complications associated with juvenile diabetes?

Type 1 diabetes is a metabolic condition in which the body does not make sufficient insulin where by the patient reguires insulin for survival. It is mostly an autoimmune disease. READ MORE
Type 1 diabetes is a metabolic condition in which the body does not make sufficient insulin where by the patient reguires insulin for survival. It is mostly an autoimmune disease. The autoimmune process destroys the insulin producing cells and blood glucose gets uncontrolled. Therefore insulin is important not only to manage the diabetes but also for survival. If diabetes is left untreated with insulin, this can lead to diabetes coma, organ failures and death. But with proper treatment the patient can live (almost) normal life.
There are acute and chronic complications of uncontrolled diabetes.
The acute complications of uncontrolled diabetes are severe 1) hypoglycemic symptoms, dizziness, lightheadedness, headache, jiteriness. Sometimes it can lead to seizures (from too much insulin). 2). Diabetic ketoacidosis which can lead to coma (from too little insulin).
There are also chronic complications of uncontrolled diabetes such as eye disease, kidney disease, nerve disease, high cholesterol etc.
Since uncontrolled diabetes have grave consequences it needs to be treated properly to avoid these short term and long term complications.
When diabetes is well controlled the patient should be able to continue normal life like any normal person.
You should talk to your doctor, especially your endocrinologist or diabetes educator about these issues.
Good luck

My son has juvenile diabetes. Can this lead to kidney problems?

If your son has type 1 diabetes (insulin-dependent diabetes), he needs to be managed well with insulin. If his diabetes is not well-controlled, it can lead to chronic complications READ MORE
If your son has type 1 diabetes (insulin-dependent diabetes), he needs to be managed well with insulin. If his diabetes is not well-controlled, it can lead to chronic complications such as eye disease, kidney disease, nerve disease, and others diseases. But if it is well-controlled, it will be less likely to have the above chronic complications of diabetes. So, the key to prevent these complications is to maintain good control of the diabetes. You should talk to your doctor about these issues and work out with him to maintain well-controlled diabetes.
Good luck.

My daughter has hyperthyroidism. Is this a "forever" condition?

Hyperthyroidism is mainly an autoimmune disorder where by the body's immune system makes antibodies that continuously stimulate the thyroid gland to make excessive thyroid hormone READ MORE
Hyperthyroidism is mainly an autoimmune disorder where by the body's immune system makes antibodies that continuously stimulate the thyroid gland to make excessive thyroid hormone (thyrotoxicosis or toxic thyroid). This autoimmune disease is called Grace's disease. There are other causes of hyperthyroidism as well. But in children, the most common cause is graves disease. This disease is mostly treated with antithyroid medications. In the USA, we use mainly methimazole and PTU. Of course, radioiodine ablation and surgically removed are other options if appropriate.

When the thyroid is treated with antithyroid medications for about 2 years, about 25%-30% may go into remission when antithyroid medications are discontinued. Therefore, the answer to your question is, in some, hyperthyroidism will have remission. Some will require long-term treatment, and others may require surgical removal or radioiodine ablation. Since medicine is an art, the decision is left to the patient and the physician to determine the best treatment option.
Good luck.

How is juvenile diabetes managed in small children?

Diabetes in young children is very challenging. The basic principles are to learn carbohydrate counting and learn the use of insulin regiment. Since young children are grasers, READ MORE
Diabetes in young children is very challenging. The basic principles are to learn carbohydrate counting and learn the use of insulin regiment. Since young children are grasers, it is hard to regiment them into fixed meals and snacks. The most reasonable thing to do will be try to regiment the child in a reasonable way without too much restrictions. You need to see a dietician for proficient carbohydrate counting, and learn flexible insulin regiment either using basal bollus regiment or insulin infusion pump therapy. In young children pump therapy may be more advantageous since it gives you more apportunity to bollus every time the child eats. You will also have a better control of blood glucose since you will do more blood glucose testing.
There are also blood glucose sensors to help you with the control of the blood sugar. Some sponsors are integrated to the pump. Some pumps can act close to artificial pancreases.
At this time you have all the above advantage that were not available before. So contact your doctor and discuss about these issue. It should not be difficult to manage any child with diabetes in 2018. Good luck.

My son does not seem to be growing at the same rate as his classmates

Most children grow close to thier genetic background (roughly 85%of the time). There are several reasons why children may be growing either below biological background, below normal READ MORE
Most children grow close to thier genetic background (roughly 85%of the time). There are several reasons why children may be growing either below biological background, below normal growth channel, or falling off the growth chart(shifting growth centiles down word.

Is it necessary to bring my child to an endocrinologist?

It depends how old your daughter is and if she has medical problems. If she started puberty after the age of 8 years and there are no medical concerns she doesn't need to see an READ MORE
It depends how old your daughter is and if she has medical problems. If she started puberty after the age of 8 years and there are no medical concerns she doesn't need to see an endocrinologist. You may see your primary care physician for regular visit and discuss it with the doctor. But if she have a medical problem or your child have precocious puberty (puberty before age of 8 years) or if your child have developmental issue, your primary care physician need to refer you to an endocrinologist for further evaluation. But simply starting normal puberty without any other medical problem is not a reason to see an endocrinologist.
Good luck

If my daughter has an overactive thyroid, will she be overweight?

The thyroid gland is supposed to make normal amount of thyroid hormone to help us maintain energy balance. But sometimes it may produce too little or too much. When it makes to READ MORE
The thyroid gland is supposed to make normal amount of thyroid hormone to help us maintain energy balance. But sometimes it may produce too little or too much. When it makes to little we call it under-active. When it makes too much thyroid hormone, it causes thyrotoxicosis, which is thyroid over activity. When it makes too much, it causes metabolic over-activity, which causes weight loss not weight gain. The opposite is true when it is under-active.
Please don't confuse it with high TSH. In hyper thyroid (toxic thyroid) TSH is supposed (low). The opposite is true with under-active thyroid, with some exceptions.
So, in hyperthyroidism, weight loss, not weight gain is expected.
Good luck.

What is the connection between low ferritin level and thyroid?

Ferritin is a protein in the blood which stores iron. Low ferritin can leads to anemia and the symptoms of anemia. Low ferritin may also lead to persistent low thyroid hormone READ MORE
Ferritin is a protein in the blood which stores iron. Low ferritin can leads to anemia and the symptoms of anemia. Low ferritin may also lead to persistent low thyroid hormone level. Iron (ferritin) is important in the synthesis of thyroid hormone. Also, low thyroid can cause low ferritin. It is therefore important to treat ferritin deficiency or iron deficiency. And treat hypothyroidism if indicated. Ideal ferritin level should be > 100ng/ml. You need to discuss with your physician to correct ferritin level. If the thyroid level is low enough, it needs to be addressed.
Good luck

Can juvinile diabetes be reversed?

Juvenile diabetes is a metabolic state of Insulin deficiency. It is mostly an autoimmune disorder where the bodies immune cells (lymphocytes) destroy insulin producing cells called READ MORE
Juvenile diabetes is a metabolic state of Insulin deficiency. It is mostly an autoimmune disorder where the bodies immune cells (lymphocytes) destroy insulin producing cells called islet cells. For diabetes to develop at least 80-85% of islet cells have to be destroyed. Once juvenile diabetes sets in, treatment is only insulin. When treatment is started there maybe more improvement with most patients going through a period of honeymoon for a short period of time. Mostly honeymoons lasts about 2 months. In almost all cases juvenile diabetes is not reversible. There are few exceptions of course. Therefore, in most cases juvenile diabetes is treatable but not reversible
You also need to discuss this issue with your physician.
Good luck

My daughter is 12 years old and is obese. Do you suggest a bariatric surgery for her?

Weight loss is very challenging. We gain more weight when we take more calories than we can burn. We are also becoming less active. Some people also gain weight because they have READ MORE
Weight loss is very challenging. We gain more weight when we take more calories than we can burn. We are also becoming less active. Some people also gain weight because they have a better gene (thrift gene). Some gain due to hormonal imbalance. Some have genetic and development problems which make them gain more weight.
The important steps in weight management are diet, exercise and behavioral modifications. Metabolic, genetic and hormonal causes need to be ruled out. If the above treatment fails, medical therapy should be tried. Those would include metformin, topamax, contrave, phentermine, saxenda, belvic, qysmia, HCG etc on selective bases.
Bariatric surgery is rarely recommend on children. First a child may not be able to concent to the procedure. Second there are significant adverse events. Third surgeons may not feel comfortable to perform the procedure on a growing child.
But if there are gross comerbidities and that it is deemed necessary to have the procedure it maybe considered.
The answer to your question is bariatrics is not likely in children unless the comerbidities (such as severe forms of prader Willi syndrome) are bad and you find a center to do it.
Good luck

My daughter has been advised Thyronorm 25mg. Will it be lifelong?

The thyroid gland is one of the very important hormone producing gland in the body. It makes thyroid hormone that controls our energy balance. But it doesn't function properly READ MORE
The thyroid gland is one of the very important hormone producing gland in the body. It makes thyroid hormone that controls our energy balance. But it doesn't function properly all the time for every body. In some people it makes less (under-active). In others it makes more (overactive).
When it is under-active (making less hormone), the person needs thyroid hormone replacement to mentain normal energy balance. The treatment could be with verious different medications, including synthroid, levothyroxine, levoxyl, armour thyroid, NP thyroid, Nature thyroid, thyronorm etc. So thyronorm is a treatment for under-active thyroid. Don't get confused with elevated TSH which is mostly a sign of low thyroid production.
Hypothyroidism (under-active thyroid) as in your daughter's case may resolve after a while of treatment. Some will continue to require treatment and some will resolve after a while of treatment. The same is also true for overactive thyroid condition in which about 25-30% will resolve in about 2 years of treatment.
Good luck

At what age should kids be checked for diabetes?

If there is strong family history of diabetes and the child is over weight or if there are any concerns he needs to be screened right away with blood glucose and Hemoglobin A1c. READ MORE
If there is strong family history of diabetes and the child is over weight or if there are any concerns he needs to be screened right away with blood glucose and Hemoglobin A1c. There after annual screening is reasonable unless there are clinical signs of diabetes such as excessive thirsty and urination or bedwetting. You can check his glucose if you have a machine at home. You can check fasting or two hours after a big meal. Fasting should be less than 100mg/dl and random >200mg/dl with or without symptoms are significant.
But the best and proper way is work with the primary care physician. You will get a better help.
Good luck

My daughter is 14 years old and still hasn't gotten her period. Should I be worried?

Menarche generally starts around 12 years and half for the majority girls. Some do it earlier, some late Bloomers do it later. Between 10-15 years is fine, as long as there are READ MORE
Menarche generally starts around 12 years and half for the majority girls. Some do it earlier, some late Bloomers do it later. Between 10-15 years is fine, as long as there are no other medical problems and puberty is progressing normally. If your child does not show any signs of sexual development such as breast tissue, public hair, body odor or acne she needs evaluation. But In a normal healthy child with signs of sexual development watchful waiting until the age of 15 years is reasonable.
Good luck

Can steroids impact the height of my son?

Corticosteroids are immune modulating medication. Their use in controlling verious inflamations makes them very important medications. We use them for asthma, and other inflammatory READ MORE
Corticosteroids are immune modulating medication. Their use in controlling verious inflamations makes them very important medications. We use them for asthma, and other inflammatory disease. However they also have side effects. They could make us gain excess weight, suppress growth in children, cause osteoporosis and more other side effects. We use them under many circumstances because their benefit outweighs their adverse effects.
Some inhalers for asthma are corticosteroids. They are important part of the treatment, though they could stunt growth and cause other side effects.
If your child's growth is suboptimal talk to your doctor if the inhalers could be changed. But if the steroid inhalers are more important to control the asthma, you need to discuss with you doctor to see an endocrinologist and explore the possibility of hormone therapy for his growth while he continues with his steroid inhalers.
Good luck

My son is 16 years old but his voice has still not changed. What could be wrong?

The tempo of puberty could be different for different adolescents. Usually boys show voice change around the age 13 years. Some do it early and some late Bloomers do it later. READ MORE
The tempo of puberty could be different for different adolescents. Usually boys show voice change around the age 13 years. Some do it early and some late Bloomers do it later. As the time goes by the voice becomes deeper. As long as your son is healthy and his sexual development is progressing properly he only needs watchful waiting. But if there are medical concerns and sexual development is not progressing properly, he will need proper evaluation by an endocrinologist.
Good luck

My son has hypoglycemia episodes often. What can we do to treat this?

Hypoglycemic episodes in a diabetic patient may be due to taking more insulin, skipping food, mismatch between the amount of food and insulin, a lump on the injection site, physician READ MORE
Hypoglycemic episodes in a diabetic patient may be due to taking more insulin, skipping food, mismatch between the amount of food and insulin, a lump on the injection site, physician activity etc. To avoid low blood glucose you will need to check blood glucose more often and give insulin appreciate to the amount of food consumed and the lever of blood glucose. I.e you need proper carbohydrate counting and appropriate insulin dosage. And account for physical activity as well. He should also be on flexible insulin regiment and explore the use of insulin pumps and use of blood glucose sensors. These Will help you manage his diabetes much better. Also make sure he doesn't have brittle diabetes. In that case you will need more help from your endocrinologist.
Good luck

What is the treatment for cushing treatment?

Cushing disease and cushing syndrome are medical condition of excess cortisol in the body. Cushing disease stems from an ACTH producing tumor in the brain. Cushing syndrome is READ MORE
Cushing disease and cushing syndrome are medical condition of excess cortisol in the body. Cushing disease stems from an ACTH producing tumor in the brain. Cushing syndrome is a collection of condition causing excessive cortisol out side the pituitary gland (brain). They could be due to steroids for inflammatory condition, cortisol producing adrenal tumors, and cortisol/ACTH producing tumors some where in the body.
Treatment of cushing syndrome depends on the cause of the syndrome. From removing (weaning) of steroids to removal or lowering of cortisol source either medically or surgically which ever is applicable and safer. This depends on the discussion with you and the expert in charge of the case. Besides removal of the offender surgically if applicable, medical therapy have been applied with ketoconazole metyrapone and mifepristone etc.
So you need to discuss with the expert to see which is the safest best option for your child. You can only arrive at a better conclusion when you are well informed about the treatment options.
Good luck

What could be the reason of urinary incontinence in my daughter?

Incontinence or enuresis is a condition where urination takes place involuntarily. It could be all the time or at night time (bed wetting). There are multiple causes of enuresis. READ MORE
Incontinence or enuresis is a condition where urination takes place involuntarily. It could be all the time or at night time (bed wetting). There are multiple causes of enuresis. It could be emotional, overactive bladder, poor bladder contraction, urethral blockage, due to medications (functional), etc.
If the enuresis is serious enough she needs to see her physician for proper evaluation and to figure out which of the above conditions are likely causing the incontinence. If there is a cause then the cause need to be addressed. If no cause as in most cases, then treatment plan should be worked out including behavioral and medical treatment. Desmopressin (ddAVP) and oxybutinin are some of the medications which could be used if they are appropriately indicated.
Good luck

Where we can do this procedure and how much the cost for two kids?

Managing type 1 diabetes in young children is challenging. So far, the best treatment options is flexible insulin regiment, using basal/bollus principles. You give basal insulin READ MORE
Managing type 1 diabetes in young children is challenging. So far, the best treatment options is flexible insulin regiment, using basal/bollus principles. You give basal insulin for in-between meals (fasting) and bollus for meals based on the amount of carbohydrate consumed. Subcutaneous Insulin infusion (pump) therapy could also be ideal to manage the diabetes. Use of blood glucose sensors would also be an additional benefit. Curing diabetes using using different methods have been tried. One notable advance has been islet cell transplant to the liver using human cadavers. But that requires immunosuppressant medication. This will not be ideal for children. There are other methods in the works. Stem cell therapy is one off them. But so far, we can only wait patiently until its application becomes practical.
So, the answer to your question is you have to wait until it arrives in the future. In the meantime, you will have to review the best available treatment options as mentioned above.
Good luck

Why does my son feel so hungry after taking his diabetes medication?

Diabetes is a metabolic condition where the body either lacks insulin or is resistant to the insulin depending on which type of diabetes the the patient has. That means the blood READ MORE
Diabetes is a metabolic condition where the body either lacks insulin or is resistant to the insulin depending on which type of diabetes the the patient has. That means the blood glucose is high. In untreated or uncontrolled diabetes blood glucose spills through the kidneys. The person losses calories and losses weight.
But when diabetes gets treated with insulin or oral hypoglycemic agents the body starts to utilize the calories efficiently and the person feels hungry. Because insulin is given under the skin it lasts longer than the natural insulin from the body. This can cause low blood glucose which intern causes hunger. Frequent low blood glucose could cause more hunger and lead to weight gain.
Therefore you have to monitor the blood glucose more often give appropriate amount of insulin for his blood glucose and for meals.
If the patient has a new onset diabetes it is normal to feel hungry after starting treatment. Because the body will try to recover what it lost during his untreated diabetes time. So the kid will be hunger, eat more and gain weight for a couple of months.
Therefore focus on managing his diabetes the best way, to maintain near normal glycemic control not on his hunger. Of course you will feed him if he is hungry and give the appropriate amount of insulin for the food and the blood glucose.
Good luck