Hypoparathyroidism

To diagnose hypoparathyroidism, your health care provider will discuss your medical history and do a physical exam, and may suggest blood and urine tests.

Blood tests

These blood test results might suggest hypoparathyroidism:

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

A blood-magnesium level may also be done. A low blood-magnesium level may cause a low blood-calcium level.

Urine test

Parathyroid hormone acts on the kidneys to prevent too much calcium from being wasted in the urine. A urine test can tell whether your body is getting rid of too much calcium.

Other tests

Your health care provider may request additional tests, such as other blood tests or a test to check heart rhythm (electrocardiogram, ECG).

The goal of treatment is to relieve symptoms and to bring calcium and phosphorus levels in your body back into a standard range.

Treatment usually includes:

• Oral calcium. Oral calcium supplements — as tablets, chews or liquid — can increase calcium levels in your blood. However, at high doses, calcium supplements can cause digestive 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. Calcitriol is a prescription from your health care provider for active vitamin D. This is different from the usual supplements you can get without a prescription.
• Magnesium. If your magnesium level is low and you're experiencing symptoms of hypoparathyroidism, you may need to take a magnesium supplement.
• Thiazide diuretics. If your calcium levels remain low even with treatment, or if the amount of calcium in your urine is very high, thiazide diuretics can help decrease the amount of calcium lost through your urine.
• Parathyroid hormone replacement. The U.S. Food and Drug Administration (FDA) has approved parathyroid hormone (Natpara) for low blood calcium due to hypoparathyroidism. This is a once-daily injection. Because of the potential risk of bone cancer (osteosarcoma), a risk observed in animal studies, this drug is available only through a restricted program. The program limits use to people whose calcium levels can't be controlled with calcium and vitamin D supplements and who understand the risks.

Diet

Your health care provider might recommend that you consult a registered dietitian, who is likely to advise a diet that's:

• Rich in calcium. This includes dairy products, green leafy vegetables, broccoli and foods with added calcium, such as some orange juices and breakfast cereals.
• Low in phosphorus. This means avoiding carbonated soft drinks, which contain phosphorus in the form of phosphoric acid, and limiting processed foods, meats, hard cheeses, nuts and whole grains.

Intravenous infusion

If you need immediate symptom relief, you may need to stay in the hospital so that you can receive calcium by a small tube in a vein in your hand or arm (intravenously). You'll also take oral vitamin D tablets. After you leave the hospital, you'll continue to take calcium and vitamin D tablets.

Monitoring

Your health care provider will regularly check your blood to monitor levels of calcium and phosphorus. At first, these tests will probably be weekly to monthly. Eventually, you'll need blood tests just twice a year. Regular testing allows adjustment of your supplemental calcium dose if your blood-calcium levels rise or fall.

Because hypoparathyroidism is usually a long-lasting disorder, testing and treatment generally is lifelong.

You'll likely start by seeing your primary care provider. You might then be referred to a specialist in treating hormone disorders (endocrinologist).

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

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting for a specific test. Take a family member or friend with you, if possible, to help you remember the information you're given.

Before your appointment, make a list of:

• Your symptoms, including those that seem unrelated to the reason for which you scheduled the appointment, and when they began
• Key personal information, including major stresses or recent life changes and your and your family's medical history
• All medications, vitamins, herbs and other supplements you take, including doses
• Questions to ask your health care provider

Questions to ask may include:

• What is likely causing my symptoms?
• 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?
• Should I see a specialist?
• Do I need to change my diet?
• Are there brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you questions, including:

• Have you recently had surgery involving your neck?
• Have you received radiation therapy to your head or neck or therapy 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?