Hypoparathyroidism
Also known as: Underactive parathyroid, Parathyroid hormone deficiency
Hypoparathyroidism is a rare condition in which the parathyroid glands produce too little parathyroid hormone (PTH), leading to low calcium and high phosphate levels in the blood. Because calcium is essential for nerve and muscle function, low levels cause tingling, muscle cramps and spasms, and in severe cases seizures or heart rhythm problems. The most common cause by far is damage to or removal of the glands during thyroid or neck surgery; less often it is autoimmune, genetic or due to very low magnesium. Treatment traditionally relies on calcium and active vitamin D supplements to keep calcium in a safe range, with careful monitoring to protect the kidneys. Recombinant parathyroid hormone is an option for people who are not well controlled with standard therapy.
At a Glance
- Common symptoms
- Tingling or burning in the fingertips, toes and around the mouth, Muscle aches, cramps or painful spasms, especially in the hands, feet and face, Twitching of facial muscles
- Main treatments
- Oral calcium supplements taken in divided doses through the day, Active vitamin D (calcitriol or alfacalcidol), which is needed because PTH normally activates vitamin D, Correcting magnesium deficiency, which can restore PTH secretion if that is the cause
- Category
- Endocrine · Rare; most cases follow thyroid or neck surgery
- See a doctor if
- Tingling around the mouth or in the hands and feet, especially after neck surgery
Symptoms
Causes
- Injury to or removal of the parathyroid glands during thyroid, parathyroid or other neck surgery (the most common cause)
- Autoimmune attack on the parathyroid glands, sometimes as part of a wider autoimmune syndrome
- Genetic conditions such as DiGeorge syndrome, in which the glands fail to develop
- Severe magnesium deficiency, which blocks PTH release
- Radiation treatment to the neck
- Rarely, infiltration of the glands by iron overload or other diseases
Risk Factors
- Recent or past thyroid or neck surgery
- Autoimmune conditions such as Addison's disease or type 1 diabetes
- A family history of hypoparathyroidism or related genetic syndromes
- Radiation to the neck
- Chronic alcohol use or gut disorders that cause low magnesium
Diagnosis
- Blood tests showing low calcium, high phosphate and low or inappropriately normal PTH
- Magnesium, vitamin D and kidney function tests
- Physical signs such as facial twitching when the cheek is tapped (Chvostek's sign) or hand spasm with a blood pressure cuff (Trousseau's sign)
- An ECG to check for heart rhythm changes from low calcium
- Genetic testing or autoimmune screening when there is no surgical cause
Treatment
- Oral calcium supplements taken in divided doses through the day
- Active vitamin D (calcitriol or alfacalcidol), which is needed because PTH normally activates vitamin D
- Correcting magnesium deficiency, which can restore PTH secretion if that is the cause
- Intravenous calcium in hospital for severe symptoms such as spasms, seizures or heart rhythm problems
- Thiazide diuretics in some cases to reduce calcium loss in the urine
- Recombinant parathyroid hormone injections for people whose calcium cannot be kept stable on standard treatment
- Supportive: regular blood and urine monitoring to avoid both low calcium and the kidney stones and calcification that overtreatment can cause
Prevention
- Most cases cannot be prevented, but surgical hypoparathyroidism is less likely with an experienced thyroid surgeon
- Take calcium and vitamin D exactly as prescribed and never stop them abruptly
- Attend regular monitoring appointments so doses can be adjusted
- Stay well hydrated to protect the kidneys
- Maintain adequate magnesium through diet and limit alcohol
- Carry a medical alert card or bracelet stating you have hypoparathyroidism
When to See a Doctor
- Tingling around the mouth or in the hands and feet, especially after neck surgery
- Muscle cramps or spasms that are severe or spreading
- Seizures, fainting, breathing difficulty from throat spasm, or an irregular heartbeat (seek emergency care)
- Vomiting or diarrhoea that prevents you taking your supplements
- Symptoms of too much calcium, such as nausea, thirst, frequent urination or confusion
Frequently Asked Questions
Related Conditions
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