Hypoparathyroidism

A rare condition in which parathyroid glands produce reduced parathyroid hormone (PTH) levels is called hypoparathyroidism. These hormones are very important in regulating and balancing two minerals in the body (phosphorus and calcium). Therefore, low parathyroid hormone levels may lead to extremely low calcium levels and high phosphorus in the blood.

In most cases, supplements that return phosphorus and calcium levels to normal help treat the condition. Sometimes, people need to use supplements for the rest of their lives or parathyroid hormone replacement if supplements do not work.

Symptoms

The symptoms of hypoparathyroidism are related to reduced calcium levels in the blood. Check below some examples:

• Muscle cramps or aches that frequently happen in the stomach, face, legs, or feet
• Extreme tiredness (fatigue)
• Weakness
• Tingling or burning in the toes, lips, or fingertips
• Sometimes muscle spasms or twitching may occur, particularly around the amount and in the hands, arms, or throat
• Patchy hair loss
• Brittle nails
• Coarse and dry skin
• Mental disorders (such as anxiety, depression, and others)
• Painful menstrual periods

If you suspect you have hypoparathyroidism or experience any of the previous symptoms, do not hesitate to visit a doctor.

Causes

This condition occurs when parathyroid glands do not produce enough hormones to maintain normal calcium and phosphorus in the blood. Parathyroid glands are four small glands behind the thyroid gland. Check below what happens if calcium and phosphorus levels become unbalanced:

• Calcium – This is an essential mineral responsible for maintaining healthy bones and teeth. If calcium levels become too low, it may lead to cardiovascular problems, osteoporosis (bone loss), and other problems. In addition, calcium also helps muscles and nerves function properly.
• Phosphorus – This is a mineral found in all cells but mostly in the bones. It helps the body to make energy from food. It also helps muscles, nerves, heart, and kidneys function properly.

Check below some causes of hypoparathyroidism:

• Neck surgery – Most people experience hypoparathyroidism due to neck surgery. It usually happens due to accidental damage to or removal of the parathyroid glands. Commonly, doctors recommend neck surgery for people with thyroid gland conditions, throat or neck cancer, and others.
• Autoimmune condition – Sometimes, the immune system attacks mistakenly parathyroid tissues, which leads to stopping the production of parathyroid hormones.
• Hereditary hypoparathyroidism – In such cases, people are born either without parathyroid glands or they do not work as they should.
• Reduced Magnesium levels in the blood – Those who have decreased Magnesium levels in the blood are at increased risk of developing hypoparathyroidism. It happens because normal levels of Magnesium are required for normal parathyroid hormone production.
• Cancer treatments – Radiation therapy used to treat cancer, may destroy parathyroid gland tissues. Sometimes, radioactive iodine treatment for hyperthyroidism may negatively affect parathyroid glands leading to hypoparathyroidism.

Risk Factors

Anyone may develop this condition and the following factors put you at increased risk of getting hypoparathyroidism. For example:

• Family history of hypoparathyroidism
• Recent neck surgery
• Autoimmune or endocrine diseases (such as Addison’s disease)

Complications

Those who ignore the symptoms and do not treat hypoparathyroidism may experience certain complications that are divided into two categories such as reversible and permanent. Check below some examples:

Reversible Complications

The following complications usually improve with treatment. For example:

• Spasms of the fingers and hands that may last for long periods and be painful
• Muscle twitches or pain
• Burning or tingling sensations in the tongue, fingers, toes, and lips
• Seizures
• Kidney function problems (including kidney stones, kidney failure, and others)
• Arrhythmia (irregular heart rhythms)
• Heart failure
• Fainting

Permanent Complications

Early diagnosis and treatment can prevent permanent (irreversible) complications from happening of getting worse. However, once they occur calcium supplements and vitamin D cannot reverse them. Check below some examples:

• Changes in the bone shape and poor growth
• Delayed mental development (in children)
• Calcium buildup in the brain may cause seizures, movement, and balance problems
• Cataracts that cause cloudy vision
• Teeth problems that negatively affect dental enamel and roots

How to Prevent Hypoparathyroidism?

Generally, there is no way to prevent this condition but you can talk with your surgeon about the risk of parathyroid gland damage if you have scheduled neck surgery. Doctors may also test your vitamin D, calcium, and parathyroid hormone levels before surgery and recommend some supplements if needed.

Sometimes, parathyroid autotransplantation may be an option that helps to reduce the risk of postoperative hypoparathyroidism. Thus, surgeons will preserve parathyroid tissue in the neck during surgery. The surgeon may also move parathyroid tissue to other body parts (such as the arm or the chest muscle) but transplanted parathyroid tissue does not function usually.

Diagnosis

Healthcare professionals to diagnose this condition will evaluate your medical history and perform a physical examination. They may also perform some tests that help to confirm the condition. For example:

• Blood tests – These tests are done to measure blood calcium level, parathyroid hormone level, and blood phosphorus level. Sometimes, doctors perform blood tests to check your magnesium levels.
• Urine tests – In normal circumstances, kidneys prevent too much calcium from passing in the urine. If you have low parathyroid hormones the level of calcium in the blood will increase. This test helps doctors determine the amount of calcium that passes in the urine and leaves the body.
• Other tests – In some cases, doctors may perform additional tests such as an electrocardiogram (EKG or ECG) to check the rhythm of the heart.

Treatment

The treatment focuses on returning levels of calcium and phosphorus within normal ranges and reducing the symptoms. Check below some treatment options usually recommended by doctors:

• Calcium supplements – These supplements come as tablets, chews, or liquids. Calcium supplements help to supply levels of this mineral in the blood. Follow the doctor’s recommendations carefully because high calcium levels may cause some digestive adverse reactions (such as constipation).
• Vitamin D – People who administer high doses of vitamin D in the calcitriol form may help the body supply calcium and get rid of phosphorus. Moreover, over-the-counter (OTC) calcium supplements are different from calcitriol, which is a prescription form of vitamin D. Consult with your doctor for more details.
• Magnesium – Doctors may also recommend magnesium supplements, especially if you experience hypoparathyroidism symptoms.
• Thiazide diuretics – These medicines are effective for people who still have low calcium levels during treatment but high calcium in the urine.
• Parathyroid hormone replacement – This treatment option is approved by the FDA (the U.S. Food and Drug Administration) for people with reduced calcium levels due to hypoparathyroidism. It involves one daily injection but due to the high risk of serious adverse reactions (such as bone cancer or osteosarcoma), this medicine should be given only through a restricted program. That’s why this treatment option is recommended by doctors only when other treatments do not work and the patient understands the risks.

Dietary Changes

Healthcare providers recommend some dietary changes for people with hypoparathyroidism. These include:

• Calcium-rich foods – For example dairy products, green leafy vegetables, broccoli, and products with added calcium including some orange juices and breakfast cereals.
• Phosphorus-low foods – Physicians recommend avoiding carbonated soft drinks and reducing the amount of processed foods, hard cheeses, whole grains, nuts, and meats you are eating.

If you need to relieve symptoms immediately, doctors may give you some calcium intravenously in the hospital and oral tablets of vitamin D.

Frequently Asked Questions

What is the primary cause of hypoparathyroidism?

People commonly experience this condition due to damage to the parathyroid glands that happens during neck surgery.

What are the hypoparathyroidism symptoms?

• Cataracts
• Calcium deposits in the body tissues or organs
• Brittle nails
• Abnormal heart rhythm
• Abdominal pain
• Muscle spasms or cramps
• Tingling in the lips, fingers, and toes

Immediately contact your doctor if any of the previous symptoms occur.

What happens if hypoparathyroidism is left untreated?

People who ignore the symptoms and do not treat the condition may experience some complications. These include breathing problems due to larynx spasms, seizures, and others. Ask your healthcare professional if you have additional questions.