Kochar Endocrine Clinic

Hi,

I am Dr. I. P. S. Kochar, paediatric, endocrinologist and diabetologist. Today I'll be telling you something about the thyroid gland. As you can see here the thyroid gland is a very important gland found in front of the neck. It's like a butterfly like shaped gland. It's very important, produces thyroxine hormone T4 and T3 which is required for all of metabolic functions of the body. So to carry on the metabolic function, the thyroid gland with the help of the pituitary gland and the hypothalamus keeps in coordination to keep all the levels normal so all the body metabolic functions occur normally. So today I will be telling something about myths and facts about the thyroid. The first thing is that it is said that you know once children with thyroid deficiency cannot live normal adult life while actually that's not true. If the patient is taking right dose of thyroxine and right regular treatment, we can achieve normal height and normal puberty development and can lead a normal adult life in the future. Next very common myth is that you know I am overweight, so I have a thyroid problem.

More than 90% of the overweight population has normal thyroid function so that's not true. Then another myth very common myth is once you get thyroid dysfunction it is forever. It's not always true because you know there are many cases condition like subclinical hyperthyroidism, patient who have critical illness on thyroxine medicine, patient who are on drugs will get some abnormality. So they will not be having a permanent hypothyroidism. Now another very common myth is that hyperthyroid mothers or thyroxine treatment deliver abnormal children. That is not at all true. If the mother is taking proper thyroxine medicine and she is taking medicines regularly, the children born are all normal.

Nowadays a policy to you know they are always doing screening for mother for thyroid before their pregnancy occurs. So that's another thing to be understood very common myth. Then another very common myth is when a woman becomes pregnant she has to discontinue all medicines including those for the thyroid. That is not that's not true. You have to continue to take your medicines of thyroid as long as a pregnancy, in fact some time you might have taken higher dose of thyroxine during that time. So there is nothing like this. So another myth very common myth is a woman with hypothyroidism will give birth to hypothyroid child. No, it is never like that. There is no genetic transmission of this disease. So it's not that if mother is hypothyroid, child will definitely be hypothyroid. So yes screening is being done otherwise universal screening is done for all the babies who are born; even mother is hypothyroid or not thyroid, they are doing it. So therefore there is with testing you know understood.

Then very common myth is hypothyroid patients cannot have children. So that's another big myth. So there is not true that you know that hyperthyroid mother can also. Once it's treated with thyroxine and give a thyroxine they become ok. They are like any other lady that can get pregnant. But they have to take thyroxine throughout the pregnancy, maybe the doses will change depending upon the TSH value during the pregnancy. So this also myth has to be removed. Then use of you know hypothyroid if detected in pregnancy like this is very common myth the third fourth trimester you know then they have to have a termination. No, there is nothing like that.

The most of the studies have shown that you know once if they are starting with thyroxine in 3rd month of pregnancy they'll deliver normally. So there with this myth is also wrong. Another very common myth is that you must do all the tests for thyroid function tests in the morning empty stomach. No, there is nothing like that. TSH can be done empty or not empty stomach. But yes if you are doing the T4 then that should be done before the medicine is taken. So therefore irrespective of medicine taken, irrespective of fasting you can do thyroid especially the TSH test. Then another very common myth is using of you know steroids for infers like thyroiditis. So this also is not necessary. No need to do anything of that, no need of steroids, need for thyroid, it's an auto-immune phenomena and it'll just need to give replacement with thyroxine. Very common myth along with this myths are that you know the body is going is no if I do not lose weight because I have hypothyroidism. So I cannot loose, that is not that's true.

Hypothyroidism the gain of weight is 3 to 4 kgs only. So if that 3 or 4 kgs weight is gained that's enough. So therefore there're lot of myths which are going on with hypothyroidism because I have hyperthyroidism and I am overweight, because hypothyroidism cannot become pregnant, I cannot have children, if I have hyperthyroidism I cannot my child will be abnormal. So we have to get rid of all these myths. So once once you know that the hyper there's a treatable condition of thyroid is hyper and once you take your drugs properly, there is no need to get worried about this. More and more awareness has to be created in the society that this is a treat condition. You just need to replace with medicine and it is not a disease to get to be get worried or worried about.

Thank you.

Hi,

I am Dr. I. P. S. Kochar. Today I will telling something about diabetes. So diabetes is a group of metabolic diseases which results in high blood sugar. There are many types of diabetes: type 1, type 2, gestation diabetes. Now there is something called as neonatal diabetes, then there is something called as MODY maturity diabetes of the young. So here we will be today we talk about childhood more of childhood diabetes. In childhood we normally have you know type 1 diabetes and we have type 2 diabetes, we also have MODY mature onset diabetes of young. Now in type obesity what is happening is either the pancreas is not functioning or the pancreas functions but insulin not able to act on the cell. So that's why you have type 1 and type 2 diabetes. Now diabetes is not discriminated between old and young. You can have diabetes in children even in a you know a toddler, infant they can also have diabetes. There are approximately 1.2 lakh children at presently in India who are suffering from diabetes, mainly type 1diabetes. Although type 2 is also coming up because of the you know obesity and other problems of the lifestyle resulting in type 2 diabetes in adolescence population, even in children of 10 years old. So it's very important to understand the type because many times it will miss.

There're a lot of you know there are not very good sign or there are no such sign very subtle, so you miss diabetes. Even physician can miss diabetes in you know children because it's like it's similar symptom with other other conditions. Now why you should suspect diabetes if the child is passing excessive amount of urine and if the child is very thirsty, if the child is losing weight, if the child is getting some infections in the body or if you feel the child comes to you after playing and you see lack of energy, he is always feeling tired very faster. Then this is there. So one should think of diabetes also if you know the child is passing urine someplace and a lot of ants collect there or the child was free you know was free of bed wetting and now starts fresh bed wetting, so one should think of that. One a child who is having who was ill and is having lot of urine passing, so in child with mild dehydration and still having polyurea passing by and you think of diabetes. So there are something if the child is unconscious, comatose, drowsy one must think of diabetes in children.

So therefore you have to think of it and keep it in mind because it can be neglected, never thought of or may not be known. So the important thing is what should be done for this? It's very simple. You have to be told that insulin is life saving for them. They have to be told nothing to worry. Now very important is education diabetes education is very very important in diabetes management because if they are just told that you know if they are taking control of their sugar, they'll lead a normal life. They'll be going to school like any other children, they'll be having a normal life, they'll play like any other children, they'll eat also like. See as we tell any normal child to have a healthy diet, we tell them also to take a healthy diet. So we're not you make them eat unnecessary things which are not good for them. You know many many like processed food, we don't advise it to any child. So basically they'll be like any other child but only they'll be taking insulin. So they have to be counselled very well, the parents have to be told because when it comes the parents are very much depressed, my child got diabetes, why this happened, why the so they have to be explained to them, counselled well that everything will be normal and life will go on and they'll only have to take insulin.

Keep a good control of their sugars so that the complications do not occur, there're very good modalities now in the available like using of insulets between the past and the insulin syringes. Now we have lot of pens, we have new insulins, we have analog insulins, we have got good insulins also, decided. The delivery of insulin method has been changed for like you are either told you have pens, now pumps are available, insulin pumps. These are devices which deliver insulin in a way like a normal pancreas. So you can deliver insulin in a in the normal pancreas delivery. So you can all as you can have a at the meals time they'll be different insulin and at the time whole day the basal insulin runs and with this the control of the sugar is very good. They can live a very good life. The complication rates become very very less. The main aim idea is to to avoid the complications to occur. So as you see the things have changed a lot now. Children should be reassured, parents should be reassured, counselling should be done well and I think they can fight against diabetes which is not going to be a problem for the small children.

Thankn you

I am Dr I.P.S Kochar, pediatrics, endocrinologist and diabetologist. Today I will be talkingt to you about Child Obesity which is becoming prevealant and epidermic in India and other countries also. So, it is increasing day by day. More than 65 million of the people are facing Child Obesity under the age of 5 years.

So, if you have any child or infant who is obese. The child will have to suffer from many problems in future.

What do you mean by Obesity?

Obesity means there is an abnormal or excessive fat accumulation in the body. So, over weight and Obesity, both are same. Obesity can cause number of problems. There are many types of complications, those are;

• In future, a child can have heart disease. THese are all metabolic problems.
• There are more chances of getting obesity in adulthood.
• Child get more prone to HYpertension.
• Girls get more prone to Polycystic Ovarian Syndrome.
• Reproductive problems
• Dyslipidemia

These are some of the metabolics which can occur. Besides this, the children can have non-metabolic problems like joint pains at early stage, difficulty in walking, sleep apnea problems and there can be other psychological problems. Children may have low confidence level, low self esteem. So these are the problems which are commonly found in such patients.

What should be done to get rid of this Child Obesity?

One of the major factor is lifestyle. People are becoming technically dependent. People are using AC Cars, Children are going to AC schools and buses. The play time in the schools has decreased greatly. This is all aggrevated to cause Obesity.

The food intake has also become different. Children are consuming more of junk food. high fatty food, high salty food which is one of a major cause of Obesity.

Not only people from urban area are becoming obese but also the people from rural area. This problem is required to be solved. 

The main thing is that we have to change our lifestyle. People have to change their food habits, they have to indulge in the routine exercise. So, there is a simple formula called 5-3-2-1, where,

• 5 means taking 5 portions of veggies or fruits everyday.
• 4 means taking 4 glasses of water per day.
• 3 means 3 times mil in a day.

If you don't remember this, atleast remember 5-2-1, where,

• 2 means that do not use gadgets for more than 2  hours in a day.
• 1 hour of physical activity in a day.

So, this formula is very helpful if children follow it. So, try to take low carbohydrates, low fat, more protein in the diet. One should try to change their lifestyle because the obesity is causing all these major problems.

Now, we are getting more children of 5 years, 8 years , 10 yeras with non-communicable disease like Obesity, hypertension, diabtes. Diabtes type-2 has also started coming in the children and the adolescence population only because of the lifestyle.

Now you see many girls whop are obese at the age of 12 -18 years. THey suffering problems like impaired glucose tolerance, they are getting black areas in the neck and also they are getting reproductive problems, hair on the face, so all these problems are increasing the complications. 

I would recommend to only change the lifestyle, make changes in the food habits and try to indulge in the routine exercises.

If you want to contact me, you can do so via Lybrate or you can visit my clinic which is in Noida. But pelase do follow the above mentioned tips.

I am Dr IPS Kochar, a pediatrician and endocrine diabetologist. Today, I am going to talk on very intresting topic, Vit-D which everyone wants to know. 

So, Vit-D is essential to maintain calcium. It basically maintains the bone metabolism of the body and it is done basically through absorption of calcium from the intestine and also from renal tubular absorption of calcium. When VIt-D becomes deficient, the hormone PTH is released which tries to maintain calcium and phosphorus in the body. The deficiency of Vit-D in different groups are different. You can have it in the new born periods, in the childhood period or in the adolescence. 

So, in the new born period, children may have some features like staying more tired, the problems related to bones such as bow legs i.e, curving of legs. Then there may be some other problem which is called genu valgum in which they have knock knees. These are some conditions which you can find. These are called as Rickets. And this ricket is responsible for Vit-D deficiency.

In the country like India which has a plenty of sunlight, why we are still facing Vit-D deficiency?

• One of the reason is that lifestyle ahs changed. We are involved in more of a technical lifestyle. The best time to absorb Vit-D is 9-11 am in which one can absorb maximum amount of Vit-D. But at this time most of us are in teh office, the children are in the schools and the housewives are inside the house. So you are hardly able to absorb Vit-D.
• Secondly. there is lot of pollution which does not allow us to absorb Vit-D
• Covering of the body is another major factor.
• There is a smog which blocks the vit-D

The sources of vit-D are very few. Most of the vit-D is in non veg. But maximum of the Indians are vegetarian. The best sources of Vit-D are fish, eggs. The one important thing all vegetarian must know that they can take mushroom. This will help in maintaining the Vit-D level. So, there are least sources of VIt-D.

There are two types of Vit-D, Vit-D2 and Vit-D3.

Vit-D2 is Ergocalciferol and Vit-D3 is Cholecalciferol. So we can get maximum of the Vit-D from the sunlight which we are not getting. In order to cover up Vit-D deficiency, we need to consume Vit-D. Otherwise children may suffer from Bow legs or genu valgum. In the adolescence, people may suffer from osteomalacia in which there is pain in the legs and bones. So, all these conditions are aggravated.

How to overcome with the deficiency of Vit-D?

Regularly take Vit-D. You can either take it weekly form or in the daily form. Consulting a doctor will be helpful. Also, Vit-D prevents the chances of cancer, hypertension, Diabetes, repeated infection in the children. Everybody should take Vit-D either weekly or daily form.

Thank you very much.

Puberty
Hi, I am Dr IPS Kochar, a pediatric endocrinologist. I’m going to talk about puberty, precautions puberty or early puberty.

Puberty is a time when the child is growing in height and weight along with some feature which comes when a child matures. Now there are conditions when a child starts getting early features. If a girl starts getting breast before the age of 8 or if a boy whose testicle volume increases more than 4 ml before 9 years of age, these children are getting into early puberty. A girl if she starts getting pubic and underarm hair before the age of 8 body odour or there are lots of behavioural changes or she suddenly shot up in height. This child may be having early puberty. So these are the symptoms concerned in a girl.

In boys the testicle volume increases more than 4 ml, increase in height velocity, 6 to 8 to 10 cms in 1 year, hair on the lips and the arm, an underarm or pubic area in less than 9 years of age, behavioural changes, mood swings, the appearance of acne. The child may be going through early puberty or precautious puberty. These things they must keep in mind because there will be a change in growth pattern. Initially, the child will grow more but later the growth will be stunted. The child will not grow up to his final height. If these points are there one should be very careful. if there is early puberty you can always go to the doctor, examine the child. So, if a girl is having breasts before the age of 8 one should definitely find out what is happening with the child and same in a boy if there is an increase in testicle volume or breaking of voice or hair anywhere in his body you should always consult a doctor. There are certain specific tests which are done where lS and FSH when they can only make a diagnosis.

In a girl, you can go for ultrasound and in a boy, you can go for MRI as to know why it is happening. These are certain things that you should keep in mind especially if the boy is having breaking of voice pubic hair armpit hair, appearance of acne one should definitely go and find out what is happening. So in a girl if there is budding of breast, pubic hair and mood swings you should definitely find out what’s happening. Girls are getting early menarche at 9 and a half years and the growth is less.

So if your child has any of these symptoms you should see a pediatric endroconologist. I’m available at lybrate.com or you can come to my clinic.

Thank you
 

Signs and symptoms of diabetes in children-
I’m Dr IPS Kochar, a diabetologist and pediatric endocrinologist. Today, I will be talking about diabetes in children.

Diabetes in children is becoming a big problem in children nowadays. More and more patients are coming up type 1 and type 2 diabetes. Parents are not ready to accept that my child is having diabetes. It’s increasing problems in lifestyle. Obesity is one factor in type 2 diabetes. In type 1 diabetes if the child is losing weight there is excessive urination, bed wetting, excessive thirst, infection or vaginal infection, One must start thinking that the child is having diabetes.

In type 1 diabetes, the treatment is only insulin. One should start insulin and there is not any requirement to visit many doctors. In case 1 diabetes you have to take insulin lifelong. The symptoms start becoming better once the child is put on insulin. The urination the excessive thirst all becomes better. Fourth it is not in the family that if the father and the mother does not have diabetes why the child got diabetes. Type 1 diabetes is not genetic, it is type 2 diabetes. There are lots of new devices that have come up lot of new insulin has come up. New insulin pump has come up for children to control diabetes and have a new lifestyle and better flexibility. Diet is a very important thing that plays a myth. Children with diabetes can have a normal diet, they can have sugary things and sweets, but within limits and when they are taking insulin.

Taking a good balanced diet is equally important in children, they are growing they are in puberty and they are more prone to hyperglycemia. They are more prone to have ketoacidosis so that is why one has to be more careful while diabetic. Many of the kids are becoming more over weight and becoming more diabetic. The weight is starting increasing and they are earlier signs that the child is getting into diabetes. Because of the weight epidemic the type 2 diabetes is increasing.

• Controlling of the diet is very important in controlling diabetes.
• The intake of food should be decreased, more careful about the lifestyle, physical exercise, regular diet control, fixing the amount of calorie intake, less sweetened fruits and foods and beverages.
• If you have very sweet fruits also you will have the problem.
• Avoiding all drinks and juices should be made a point especially the intake of milk products should also be decreased.

So in type 2 diabetes, lots of good physical exercise good diet control and may be in some children using some tablet called metformin helps in children to control diabetes.

In type 1 diabetes, insulin is required and must. In some children when they pass urine the ants start collecting it is type 1 diabetes. If the child is losing weight in spite of eating properly there are chances of type 2 diabetes. If the child is feeling tired there are chances of type 1 diabetes. If the child is passing excessive urine and wetting bed, eating food and still losing weight then there is a chance of type 1 diabetes. These symptoms one must keep in mind and always be careful if you find. If the family doesn’t have the child can have diabetes because it is normally an auto known process. If your child has type 1 diabetes you should visit a pediatric endocrinologist.

If you have any queries you can contact me on lybrate.
 

Common signs of thyroid in children
Hello, friends, I am doctor IPS Kochar, pediatric and adolescent diabetologist. Today I will talk about thyroid.

Parents are concerned about their children getting thyroid. There are a lot of children who are getting thyroid these days, not only that parents also have a thyroid. The parents are concerned whether the child will get thyroid or not. The function of the thyroid gland is to produce thyroxin. Day to day metabolism is dependant on thyroxine. Deficiency of thyroxine produces hyperthyroidism. If there is a deficiency of thyroxine there are certain symptoms. Lets us first start with a baby a newborn. There is a universal function of thyroxine done. The baby may be sleeping all the time, not taking the feed properly or in later childhood, the child may be gaining weight, the child may be lethargic, the child may have stunted growth. These are the things in a child when there is thyroid involved. Along with that, the child’s growth will be affected. a

If there are very high levels of TSH there is hyperthyroidism. If there is lot of problems the child will not work properly,

• The child will be chubby.
• Short height and these things will be there.
• Adolescent girls might get menstrual problems.
• you may have less and late period.
• A gain of weight
• Infertility problems.
• Dryness of the skin.
• Loss of hair.

These are symptoms if they are present in the children must be seen by a pediatric endocrinologist. There will be conditions where there will be an excess production of TSH. There TSH is less and thyroxine is more produced in the body. So there is hyperthyroidism, the function of the thyroid is more. The gland is functioning more. Commonly seen in girls overproduction of thyroxine leading to urticaria, preparation increasing, anxiety, weight loss and food stops affecting the body. If a child gets hyperthyroidism he has to take medication lifelong. So there is a myth that this medicine that you are taking it causes problems. It has no side-effect. It is not a disease but deficiency. There is no side effect in the medicine you are taking. If the child is feeling lethargic, and stunted growth is there you should consider hyperthyroidism and go to a pediatric endroconologist.

You can connect with me via lybrate.
 

Tips for growth of your child-
 

Hello friends, I am doctor IPS Kochar, pediatric and adolescent diabetologist. Today, I will be giving you some health tips first of all on growth. Growth is a very important parameter for children who are growing. A lot of parents are concerned if my child is growing well or not. When a newborn is born his height is around 50 cm and around two years his length is around 75cm at the age of approximately 1 year. When a child is 50 cm he grows by 25 cm first year and grows around 12.5 cm in the next year and another 6 cm every year. So he is about 100 cm at 4 years of age. If a child is growing less than 5 cm a year that is a little concern and the parents should worry about. If child is not gaining height properly in the sense the child is not having a change in dress in the last 1 year or if the shoe size is not increasing in the last 2 years, he is shortest in the class, he is being checked by the doctor and it is found that the growth is less. So these are the ways to pick up children who are not growing. There might be the complaint from his peer group that he is not being able to play with the rest of his friends. These are things one should be little concerned of if growth is not occurring properly.

Growth is also dependant on many factors. It depends on nutrition, sleeping pattern, parent’s height and other factors like hormones. If a child is not growing properly he should be consulted a pediatric endocrinologist, why he is not growing properly. The role of the parents in this is to make sure that the child is getting good nutrition, good sleep, good physical exercise will help a lot. When you are finding out that the child is not growing properly then you should measure and see if the child is growing less than 5 cm a year, that is a big concern. This is one parameter where the child is not growing.

There may be other reasons to it, may the parents are short, the child is short. It may be possible because of constitutional delay, that is when you have parents also who had their late bloomers, periods in the girl's matter came late in the mother or the beard and the moustache might have come late in the father. this is then called as a constitutional delay but the other factor is that the child having a systemic disease like a lung disease, git disease, growth hormone deficiency. So it is very important from the point of view of growth, one should monitor the child’s growth and the parents should be concerned whether my child is growing properly or not because people have only 1 to 2 children nowadays and they all want their children to grow tall and good. Height makes a lot of differences.

If your child is not growing properly you should consult an pediatric endocrinologist.

You can contact me via lybrate.