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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
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
Tests and diagnosis
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.
Treatments and drugs
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.