Hypoparathyroidism is an uncommon condition in which your body secretes abnormally low levels of parathyroid hormone (PTH). PTH plays a key role in regulating and maintaining a balance of your body's levels of two minerals — calcium and phosphorus.

The low production of PTH in hypoparathyroidism leads to abnormally low ionized calcium levels in your blood and bones and to an increase of serum phosphorus.

Treatment for hypoparathyroidism consists of taking supplements to normalize your calcium and phosphorus levels. Depending on the cause of your hypoparathyroidism, you'll likely need to take supplements for life.

Signs and symptoms of hypoparathyroidism can include:

  • Tingling or burning (paresthesias) in your fingertips, toes and lips
  • Muscle aches or cramps affecting your legs, feet, abdomen or face
  • Twitching or spasms of your muscles, particularly around your mouth, but also in your hands, arms and throat
  • Fatigue or weakness
  • Painful menstruation
  • Patchy hair loss, such as thinning of your eyebrows
  • Dry, coarse skin
  • Brittle nails
  • Headaches
  • Depression, mood swings
  • Memory problems

When to see a doctor

If you have any of the signs and symptoms associated with hypoparathyroidism, make an appointment with your doctor for an evaluation. Contact your doctor immediately if you have a seizure or have difficulty breathing, both of which can be complications of hypoparathyroidism.

Hypoparathyroidism occurs when your parathyroid glands don't secrete enough parathyroid hormone. You have four parathyroid glands — each normally about the size of a grain of rice — situated in your neck, adjacent to your thyroid gland.

The low production of PTH leads to abnormally low calcium levels (hypocalcemia) in your blood and bones and to increased levels of serum phosphorus (hyperphosphatemia).

Factors that can cause hypoparathyroidism include:

  • Acquired hypoparathyroidism. This most common cause of hypoparathyroidism develops after accidental damage to or removal of the parathyroid glands during surgery. This surgery may be a treatment for diseases of the nearby thyroid gland, or for throat cancer or neck cancer. Today, surgeons are more careful to avoid injuring the parathyroid glands during surgery.
  • Autoimmune disease. In this condition, your immune system creates antibodies against the parathyroid tissues, trying to reject them as if they were foreign bodies. In the process, the parathyroid glands stop manufacturing their hormone.
  • Hereditary hypoparathyroidism. In this form, either the parathyroid glands aren't present at birth, or they don't work properly. Some types of hereditary hypoparathyroidism are associated with deficiencies of other hormone-producing glands.
  • Extensive cancer radiation treatment of your face or neck. Radiation can result in destruction of your parathyroid glands, as can radioactive iodine treatment for hyperthyroidism, occasionally.
  • Low levels of magnesium in your blood, which can affect the function of your parathyroid glands. Normal serum magnesium levels are required for optimum secretion of parathyroid hormone.

Factors that may increase your risk of developing hypoparathyroidism include:

  • Recent neck surgery, particularly if the thyroid was involved
  • A family history of hypoparathyroidism
  • Having certain autoimmune or endocrine conditions, such as Addison's disease — a condition characterized by a deficit in hormone production by the adrenal glands

Hypoparathyroidism may result in numerous complications.

Reversible complications

The following complications are due to low calcium levels, most of which are likely to improve with adequate treatment:

  • Tetany. These cramp-like spasms of your hands and fingers may be prolonged and painful. Tetany may also include muscle discomfort and twitches or spasms of the muscles of your face, throat or arms. When these spasms occur in your throat, they can interfere with breathing, creating a potential emergency.
  • Paresthesias. These are characterized by sensory symptoms of odd, tingling sensations or pins and needles feelings in your lips, tongue, fingers and feet.
  • Loss of consciousness with convulsions (grand mal seizures).
  • Malformation of the teeth, affecting dental enamel and roots.
  • Impaired kidney function.
  • Heart arrhythmias and fainting, even heart failure.

Irreversible complications

Accurate diagnosis and effective treatment may prevent these complications associated with hypoparathyroidism, but once present, they won't improve with calcium and vitamin D treatment:

  • Stunted growth (short stature)
  • Slow mental development (or mental retardation) in children
  • Calcium deposits in the brain, which can cause balance problems and seizures
  • Cataracts

You're likely to start by seeing your family doctor or a general practitioner. You may then be referred to a doctor who specializes in treating hormone disorders (endocrinologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Write down your symptoms, even those that seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you're taking.
  • Ask a family member or friend to accompany you, if possible. He or she may remember something you missed or forgot.
  • Write down questions to ask your doctor.

Preparing a list of questions may help you make the most of your time with your doctor. For hypoparathyroidism, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • Other than the most likely cause, what are other possible causes?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available, and which do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • How can I best manage this condition with my other health conditions?
  • Do I need to modify my diet?
  • Do you have brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did your symptoms begin?
  • Have you had recent surgery involving your neck?
  • Have you received radiation therapy to your head or neck or for treatment of thyroid problems?
  • Has anyone in your family had similar symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Medical history

A doctor who suspects hypoparathyroidism begins by taking a medical history and asking about your symptoms, such as muscle cramps or tingling of your toes, fingers or lips. He or she will want to know whether you've had recent surgeries, particularly operations involving the thyroid gland or your neck.

Physical exam

Next, your doctor will conduct a physical examination, looking for signs that suggest hypoparathyroidism, such as facial muscle twitching.

Blood tests

You'll also have blood tests, and the following findings may indicate hypoparathyroidism:

  • A low blood-calcium level
  • A low parathyroid hormone level
  • A high blood-phosphorus level
  • A low blood-magnesium level

Your doctor may also order a urine test to determine whether your body is excreting too much calcium.

In diagnosing children, doctors check to see whether tooth development is normal and whether they have met developmental milestones.

The goal of treatment is to relieve symptoms and to normalize levels of calcium and phosphorus in your body. A treatment regimen typically includes:

  • Oral calcium carbonate tablets. Oral calcium supplements can increase calcium levels in your blood. However, at high doses, calcium supplements can cause gastrointestinal side effects, such as constipation, in some people.
  • Vitamin D. High doses of vitamin D, generally in the form of calcitriol, can help your body absorb calcium and eliminate phosphorus.

Some studies have shown benefits of treatment with recombinant human parathyroid hormone (PTH), currently used to treat the bone-thinning disease osteoporosis. However, it's not approved for treatment of hypoparathyroidism.

Dietary steps

Your doctor may recommend that you consult a dietitian, who is likely to advise a diet that is:

  • Rich in calcium. This includes dairy products, green leafy vegetables, broccoli, kale, and fortified orange juice and breakfast cereals.
  • Low in phosphorus-rich items. This means avoiding carbonated soft drinks, which contain phosphorus in the form of phosphoric acid, and limiting eggs and meats.

Intravenous infusion

If you need immediate symptom relief, your doctor may recommend hospitalization to administer calcium by intravenous (IV) infusion. These IV infusions may be important if you're having severe spasms associated with tetany. After hospital discharge, you can continue to take calcium and vitamin D orally.

Regular monitoring

Your doctor will regularly check your blood to monitor levels of calcium and phosphorus. Initially, these tests will probably be weekly to monthly. Eventually, you'll need blood tests just twice a year.

Because hypoparathyroidism is a long-lasting (chronic) disorder, treatment generally is lifelong, as are regular blood tests to determine whether calcium in particular is at normal levels. Your doctor will adjust your dose of supplemental calcium if your blood-calcium levels rise or fall.

If calcium in your blood remains low despite treatment, your doctor may add a prescription diuretic medication — specifically a thiazide diuretic such as hydrochlorothiazide or metolazone. While some other types of diuretics (loop diuretics) decrease calcium levels in your bloodstream, the thiazides can increase blood-calcium levels.

Most people who are treated for hypoparathyroidism can keep their symptoms under control if they continue to receive treatment. Early diagnosis and treatment can help prevent complications of hypoparathyroidism, some of which are permanent.

There are no specific actions you can take to prevent hypoparathyroidism. However, if you're scheduled to have thyroid or neck surgery, talk to your surgeon for assurance that steps will be taken to avoid damage to your parathyroid glands during the procedure.

If you've had surgery involving your thyroid or neck, be alert for signs and symptoms that could indicate hypoparathyroidism, such as a tingling or burning sensation in your fingers, toes or lips, or muscle twitching or cramping. When they occur, your doctor may recommend prompt treatment with calcium and vitamin D to minimize the effects of the disorder.

May 09, 2014