Pinnacle Super speciality Clinic

Hello friends!

I am Dr. Neelam Pandey. I am consultant endocrinologist and today I'll be speaking on polycystic ovarian syndrome. As we all know it is a very common problem which is seen in our female population and here we know that there are a small cyst in the ovary and they lead to a lot of hormonal turbulence. Females can present with especially in the reproductive age group this is seen and the female and the teenagers and young ladies they complain of acne, facial hair or body hair like which we call hirsutism and they may also complain of irregular cycle, sometimes it is very delayed as good as amenorrhoea like they don't have a cycle for 3,3 4,4 months and these patients are also prone to diabetes, these patients are also prone to obesity and lipid disorders, cholesterol issues. So, identification of these patients is very essential because they have the threat to become one-third of the patient may become diabetic sooner or later and this has a lot of implications over the fertility also. Not everyone but few cases at least 15 to 20% cases may have issues in difficulty in going ahead with the pregnancy.

So, this is important, this should be checked, this should be identified. So, with the help of when you see an endocrinologist, they will examine you, they will look at your clinical condition, they have some specific scoring system for facial and other things and accordingly they plan a treatment for you and management for you; so, a battery of blood tests are being done, hormonal test profile is done along with that sugar is also checked and other parameters like testosterone levels these are being checked in blood and there is one ultrasound pelvis is being done so as to see the polycystic ovary and we follow specific criteria and after labelling and excluding other similar diseases such as we rule out hypothyroidism, we try to rule out of prolactin disorders, there are other androgen secreting glands in the body such as adrenal glands; so we try to rule out those disorders by a list of investigations.

All these, once are excluded and we know that this is the case of PCOD which we are dealing with, then treatment is told to them which is largely lifestyle modification, which is that you have to control your weight and you have to do regular exercise which we all know we should be doing it otherwise also but in this case it is definitely a sort of definitive management. So, you have to control your lifestyle largely and regular walk, low carb diet, low fat diet has to be followed and weight loss is the key but there are 10% chances of lean PCOD in which they're already lean but still diet and lifestyle modification, low carb diet is the key and then we also give sometimes hormonal and non-hormonal medication depending on the need because all the PCOD female patients may not have similar triad. They may have certain group might have just an irregular cycle; they may not have acne and hirsutism. The other group may have a regular cycle and they may have hirsutism and acne. So, accordingly as per your test and clinical condition, your treatment is chopped out and you keep yourself fit on whatever medications advised by your doctor. So it is very much possible, so instead of getting worried about the illness, look for a solution and fix your health.

Thank you so much!

Hello friends.

I am Dr. Neelam Pandey, consultant endocrinologist. Today I am going to speak upon thyroid disorders. As we all know there are 2 thyroid glands in our neck. They are very essential in production of thyroid hormone which maintains our metabolism. If the gland is producing less hormone then that entity is called hypothyroidism which is more common and if they produce more hormone then it is called hyperthyroidism. First I am going to speak about hypothyroidism which is very very common and in this entity the thyroid hormones are produced less, as a result, we suffer many symptoms and patient complain of weight gain, there can be profound swelling, they can have facial puffiness or leg swelling, period irregularity, females can have miscarriages or infertility complain can be there and they may have menorrhagia like heavy bleeding and heavy clot passage and apart from that there can be extreme lethargy, sometimes there is memory loss, sometimes people say that they have chronic urticaria or because of extreme dryness. So, routinely if you check T4 TSH in these patients especially T4 TSH should be checked and which is a blood test with that the diagnosis can be confirmed and management is very simple.

You have to simply take thyroid hormones which are available in brown colored bottle and if the TSH is 10 and above, doctor prescribes your thyroid hormones as per your body weight and as what is your TSH value. Less than 10, only few special conditions are treated such as pregnancy, infertility, irregular menstrual cycle or some hormonal issues such as hyperprolactinemia otherwise usually 10 and above values are to be treated. When the first term TSH is above 10 then the treatment is being decided and you have to be on medication, 95% of the cases will require medication all their life and on follow up your TSH is being checked and it is maintained in normal range that doesn't mean that you have to stop treatment and 3 monthly follow-up is usually done except in pregnancy and neonatal hypothyroidism when it is more frequent follow up is required with TSH. And you have to be in consultation with your doctor.

Do not increase or decrease your dosage or change brand and there are strict norms to be followed such as it has to be taken empty stomach, take it after a gap of 30 to 45 minutes, do not miss your pill, if you miss you can take your missed pill the very next day but try and avoid such situation and maintain your TSH so that you can restore your well-being. The other aspect is hyperthyroidism in which the hormone is secreted more into your bloodstream. As a result you have a lot of weight loss, palpitations, sweating, sometimes excess bowel movement like the frequent passage of stool and sometimes there is proptosis that is bulging of eyes, neck swelling and they may have tremblessness of hand. So all this can be seen in hyperthyroidism. Primarily there are two entities: one is thyrotoxicosis due to thyroiditis in which gland due to leakage of the hormone, leakage of excess hormone occurs so this entity is self-limiting. The other one is hyperthyroidism which is like autonomous overproduction of hormone in which medical management is done and that therapy is given for 12-18 weeks. Treatment is very much possible, we need not panic. We have to simply see our endocrinologist in vicinity and get routine tests which are advised by them. It is usually a blood test that is free T4 and TSH and thyroid scan which can differentiate between the thyroiditis and hyperthyroidism and accordingly treatment is planned for a patient. So thank you very much for your attention.

Thanks!

Here are prevention and management of diabetes.

Here are types, symptoms and diagnosis of diabetes.

Hi viewers I am Dr. Neelum. I am consultant in endocrinology and diabetology. Today I will be briefing you regarding diabetes because it’s a major it’s a big public health problem and it is spreading like an epidemic Diabetes is basically a disorder in which our glucose is not able to get utilized by the body for lack of insulin either or when the insulin is not able to act the way it should act in the body tissues. And in that case we have two major types of diabetes. That is type-1 Diabetes and type-2 Diabetes. In type-1 diabetes there is absolute depletion of insulin and the patients are usually lean and they are requiring insulin for their diabetes control for entire life. And type-2 diabetes patients are usually obese and they have family history of diabetes, diabetes run in their family and they usually have insulin resistance.

They can be well controlled initially with diet, lifestyle modifications and medicines. And subsequently in the late stages or maybe, when it is not controlled with the medicines, they may require insulin. Now there is another variant of diabetes that is GDM; Gestational Diabetes Mellitus which is seen in pregnant females. And why it is important to know that? Because nowadays. Due to screening of diabetes and during pregnancy it is picked and sugar controls have to be in target range because there is fetal development and metabolic programming is done so it is important to have a healthy baby for which sugars should be adequately controlled via lifestyle modification, diet, if not then insulin is also given.

Then the other less type of diabetes are also known which are syndromic diabetes, which I am going to discuss here, because the important ones and the major ones are type-1 and type-2 And the cause of concern is that initially it was thought that type-2 diabetes is seen after 40, but it is not the picture. It was always there in kids, now it is increasing in alarming proportions. The kids are more glued to the screen and gadgets and they are having more type-2 diabetes because they have sedentary lifestyle, their food choices are little, they are more into binging, snacking and they are not that much physically active. And even younger kids in their teens and, adolescence and young adults, they are also having type-2 diabetes. So all this has to be picked because they develop complications first than adults. So how do we pick whether you have diabetes or not? So the symptoms are polyphagia, osmotic symptom typically these may not be in all the patients. You have to have a high index of suspicion.  If you have family members who are diabetic or obesity or hypothyroid or hypertension, their blood sugar should be checked.

Now how do we diagnose diabetes? Well blood tests which are done to detect diabetes are very simple. They are fasting blood sugar and 2 hours pp. we have sudden cutoff. And there is one more test which is called HPA1C. So HPA1C tells you monthly average blood glucose which comes in percentage. If it is above 6.5% and fasting blood glucose is above than 126mg/dl then you are labelled as diabetes. So in this part I’ll be speaking about the diagnosis which I have just spoken and in the next part I’ll be telling you once are diagnosed with diabetes, how can you have control over the diabetes and how can you follow up to have a good glycemic control?

If you want to have online consultation, you can contact me via lybrate website or you can see me in my clinic which is located in Sushant Lok, Gurgaon.