Hypoparathyroidism

Definition
Hypoparathyroidism is a condition in which your body secretes abnormally low levels
of parathyroid hormone. This hormone 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 parathyroid hormone in hypoparathyroidism leads to

abnormally reduced calcium levels (hypocalcemia) in your blood and bones.
Hypoparathyroidism also leads to an increased amount of phosphorus
(hyperphosphatemia).

Treatment for hypoparathyroidism consists of taking supplements to normalize your

levels of calcium and phosphorus. Because hypoparathyroidism is a chronic
condition, treatment is generally lifelong.

Symptoms
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, and thinning of your eyebrows
 Dry, course skin
 Malformation or splitting of your nails
 Anxiety or nervousness
 Headaches
 Depression, mood swings
Causes

Parathyroid glands

The hormone parathyroid is manufactured by the small oval-shaped parathyroid

glands in your neck, adjacent to your thyroid gland. Each of your four parathyroid
glands is about the size of a pea.

Despite the similarity in names, the parathyroid glands are distinct from the thyroid
gland, and have different functions in your body. Hypoparathyroidism occurs when
your parathyroid glands don't secrete enough parathyroid hormone.

Doctors frequently categorize hypoparathyroidism into "hereditary" and "acquired"

forms of the condition, which relate to their cause:

 Hereditary hypoparathyroidism. In this form, either the parathyroid glands aren't present at
birth or they don't work properly. Symptoms tend to become apparent in the first 10 years of
life, and most often by about 2 years of age. This inherited genetic disorder is passed to a
child through a recessive gene. When both parents are carriers of this genetic defect, a
child's chances of inheriting the disease are 25 percent.
 Acquired hypoparathyroidism. This form tends to develop 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 or
neck cancer. Acquired hypoparathyroidism occurs less commonly than it did
in the past because surgeons are aware of and more careful to avoid injuring
the parathyroid glands in the course of surgery.

In a small number of cases of the acquired disease, the cause is an

autoimmune disorder. In this situation, 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
hormones.

Other causes
Hypoparathyroidism can also be caused by:

 Extensive cancer radiation treatment of your face or neck, which can result in destruction of
your parathyroid glands, or occasionally because of radioactive iodine treatment for
hyperthyroidism.
 Low levels of magnesium in your blood, which can affect the function of your parathyroid
glands. Normal magnesium levels are required for optimum secretion of parathyroid
hormone.
 A condition called metabolic alkalosis, in which there are chemical imbalances in your
bloodstream.

Risk factors
If you've had recent neck surgery, particularly if the thyroid was involved, you may
have an increased risk of developing hypoparathyroidism.

A family history of hypoparathyroidism also increases your risk. So does the presence
of certain autoimmune or endocrine conditions, such as Addison's disease — a
condition characterized by a deficit in hormone production by the adrenal glands.

Hypoparathyroidism occurs in approximately equal numbers of males and females.

Although it may occur at any age, it develops most commonly in children younger
than 16 and in adults older than 40.

When to seek medical advice

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

Tests and diagnosis

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

Next, your doctor will conduct a physical examination, looking for signs that suggest
hypoparathyroidism. You'll also undergo 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 these additional tests:

 Electrocardiogram (ECG). This test involves taking electrical readings of

your heart's activity. It can detect arrhythmias associated with hypocalcemia
and, in turn, hypoparathyroidism.
 Urine test. Evaluation of a sample of your urine can show whether your body
is excreting too much calcium.
 X-rays and bone density tests. These can determine whether abnormal
calcium levels have affected the strength of your bones.

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

Doctors who specialize in hormone diseases (endocrinologists) are more familiar with
diagnosing and treating hypoparathyroidism, and your general practitioner may make
a referral to such a specialist.

Complications
People with hypoparathyroidism may develop any of a number of complications. The
following complications are due to low calcium levels, and most may improve with
adequate treatment:

 A condition called tetany, which is characterized by sensory symptoms consisting of

paresthesias (odd, tingling feelings) of your lips, tongue, fingers and feet; cramp-like
spasms of your hands and fingers, which may be prolonged and painful; muscle
discomfort; and twitches or spasms of the muscles of your face, throat or arms. When these
spasms occur in your throat, they could interfere with breathing, creating a possible
emergency.
 Loss of consciousness, with convulsions (grand mal seizures).
 Malformation of the shape and size of the teeth.
 Weak bones (osteoporosis).
 Heart arrhythmias and fainting.

Other complications are associated with hypoparathyroidism, but will not improve
with calcium and vitamin D treatment:

 Stunted growth (short stature)

 Slow mental development (or mental retardation) in children
 Cataracts

Treatments and drugs

In choosing treatment for hypoparathyroidism, doctors consider factors such as your
symptoms, including their severity, and your overall health. The goal of treatment is
to normalize the levels of calcium and phosphorus in your body. A treatment regimen
typically includes:

 Oral calcium carbonate tablets.

 Vitamin D, which can help your body absorb calcium and eliminate
phosphorus. The forms of vitamin D called ergocalciferol, dihydrotachysterol
 or calcitriol are recommended most often, because they have a longer duration
of action or are more potent than are other forms of this vitamin. Often, the
required doses of vitamin D are much higher than are those used for a typical
daily vitamin supplement.

At high doses, calcium supplements can cause gastrointestinal side effects such as
constipation in some people. For that reason, take these pills only under the guidance
of your doctor.

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

 Rich in calcium. This includes dairy products, nuts, green leafy vegetables,
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. Dairy products and
some nuts also tend to be high in phosphorus.

In some cases, when you need immediate relief of symptoms, your doctor may
recommend hospitalization in order 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 as an oral supplement.

Because hypoparathyroidism is a long-lasting (chronic) disorder, treatment strategies

are generally recommended for the rest of your life, along with 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 other types of diuretics (loop diuretics)
decrease calcium levels in your bloodstream, the thiazides can increase those levels.
Even though these thiazide drugs can raise blood-calcium levels in some people, their
effectiveness is not universal.

Most people who are treated for hypoparathyroidism can keep their symptoms under
good control if they continue to receive treatment long term. This is particularly true
with an early diagnosis.

Prevention
There are no specific actions that you can take to prevent hypoparathyroidism.
However, if you're scheduled to undergo 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. When they occur, your doctor may
recommend prompt treatment with calcium and vitamin D to minimize the
seriousness of the disorder.