Dr. Tseghai Berhe, MD

Type 1 diabetes (Juvenile diabetes) is a metabolic condition where the body lacks insulin. This is mostly due to an autoimmune distribution of the insulin producing cells called islet cells. Therefore your child is perfectly healthy except that he needs to take insulin to control the blood sugars. As long as the blood sugars are reasonable and blood sugars are monitored regularly and as needed, he can participate in any spots activity like any normal healthy child.
Regular sports activity and good nutrition will make him more stronger and healthier. Having type 1 diabetes is not a contraindications for any activity as long as you monitor blood glucose and keep blood glucose levels at a reasonable range. If blood sugars are high you will give insulin if low you will feed appropriately. So children with type 1 diabetes should be able to participate in sports activity of thier linkings. Sports activity will make him stronger and also much healthier as well. I encourage you to work with you diabetes educators closely. Do not restrict physical activity just regulate blood sugars.
Good luck.

Type 1 diabetes is mostly an autoimmune process in which the immune system destroys the insulin producing cells called islet cell. Once 80% of the islet cells are destroyed, the body is not able to produce enough insulin to much the metabolic demand of the body. This is called insulin dependent or juvenile diabetes. Type 2 diabetes is usually, at least in the beginning, insulin independent. It means that the disease will respond to lifestyle changes, weight reduction, or oral medications.

If your daughter is eating sweets which are not healthy, this can lead to obesity insulin, resistance, etc., which in turn may lead to type 2 diabetes. However, eating lots of sweets is very unhealthy regardless of diabetes. Try to limit sweets and make sure she is active and maintains an ideal weight for her age. You may also need to see a nutritionist for better nutritional information.

Good luck.

A swelling on the neck could be due to many reasons. Enlarged thyroid gland can cause swelling on the neck. This is called goiter. It can be caused by either iodine deficiency or by a chronic autoimmune inflammation of the thyroid gland (Hashimatos thyroiditis). Graves disease (overactive thyroid gland) and other medical conditions can also cause enlarged thyroid gland. it is also possible to see mild thyroid enlargement in adolescence (physiological change). Goiter can occur in the face of normal thyroid hormone or abnormal thyroid hormone. Abnormal thyroid hormone can be low or high. A goiter can be with or with out nodule(s). A nodule can be benign or pathologic.
In your daughter's case, the swelling on her throat need to be evaluated to determine if this is an enlarged thyroid gland (goiter) or something else. If this is proven to be a goiter, she will need evaluation to determine if there is (are) nodules. If there is/are nodule(s), she needs ultrasound evaluation to determine the next step. she will also need assessment of her thyroid hormone levels to make sure she does not have underactive or overactive thyroid gland. It could also be enlarged thyroid gland due to physiologic changes (in adolescence).
Talk to your doctor about your concerns. He/she will help you the status of the swelling on her throat.
Good luck

Growth is affected by genetics, nutrition, physical and psychosocial and hormonal factors. Besides genetic endowment and hormones, poor nutrition and psychological or psychological deprivation can stant (restrict) growth. Loving care make children grow better than putting them in orphanage. in other words institutionalized children thrive less than children in loving homes. Nutrition is also the whole mark of maximum expression of the gene for a better growth. During the American civil war the average man was about 5feet 2 inches. At this time the average man is about 5 feet 10 inches. The gene does not change in 150 years. What has changed is nutrition. The better the nutrition is the better the growth. Similarly children who are small and picky eaters are generally small due to suboptimum nutrition.
Hormones also play a very important role in growth. Growth hormone and thyroid hormone are prime examples. Other hormones given in excess amount or produced in excess can cause growth restriction. excess cortisol is an example.
Numerous Genetic abnormalities can also interfere in growth. examples will not be discussed here because they are beyond the scope of this topic. Gastrointestinal conditions such as celiac, inflammatory bowel disease can lead to growth failure. Anemia, liver disease, kidney disease, heart disease will also stant growth. There many other medical conditions that will interfere with normal growth as well.
In your sons case there is no simple answer to your question without proper medical evaluation of your son. You can optimize his nutritional intake. you can also see a nutritionist if you think his nutritional intake is in question. Make sure you also pay attention to his weight. You do not want to create obesity in trying to promote his height growth.
Regarding hormone supplement, he needs to see his doctor to determine if he has growth problems and to determine if he is a candidate for hormone therapy . If your doctor determines there are hormone imbalances he/she will do what is appropriate to help
your son grow.
Good luck

Growth is a good measure of how a child is doing during his childhood and adolescent years. If the growth is optimum then the child may be in good health. Growth rate is also a good indicator of how a child is doing over a given interval of time. Growth is affected by genetics, nutrition, physical and psychological well-being and hormones. Growth can be measured in terms of the child's weight, hieght, head circumference, body proportions, skeletal maturation, teeth eruption etc. If hieght affected, then the child has growth failure. But if only weight is affected in the face of a normal linear hieght growth then the child may have failure to thrive.
In your child's case the height is around 50 percentile and the weight is less than 10 percentile. If he has been mentaining those proportions for a long time, then that may be fine. But if the weight has been falling of the curve over time then he needs to have proper evaluation for medical condition such as celiac disease, anemia, malabsorption, hormones or other medical conditions. You can also try to optimize his calorie intake by giving him more snacks and high calorie diet. The key is talk to your doctor and have the child basic evaluation. If the child is in good health and he mentains the same hieght and weight proportions with out shifting growth centiles, then child may not need any evaluation. Just reassurance
Good luck

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

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.

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.

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.

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.

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

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.

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

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

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

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

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

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

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

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