Hypoparathyroidism leads to abnormally low levels of calcium (hypocalcemia) and increased levels of phosphorus (hyperphosphatemia) in the body.
Hypoparathyroidism is a condition where the body produces low levels of parathyroid hormone (PTH), eventually leading to hypocalcemia (abnormally low calcium levels) and hyperphosphatemia (increased levels of phosphorus in the serum). PTH is a vital hormone that regulates and maintains the balance of calcium and phosphorus levels in the body.
What are the causes of hypoparathyroidism?
Parathyroid hormone (PTH) is secreted by four parathyroid glands in the neck that are located behind the thyroid gland. Hyperparathyroidism is a condition where the parathyroid glands don't secrete enough PTH.
Causes of hypoparathyroidism include:
- Neck surgery:
- The most common cause of hypoparathyroidism is accidental damage or removal of the parathyroid glands during neck surgery (commonly done to treat thyroid conditions or neck and throat cancer).
- Autoimmune disease:
- The immune system mistakes the parathyroid gland cells for foreign bodies and attacks them.
- Parathyroid glands stop the production of PTH because of this process.
- Hereditary hypoparathyroidism:
- The person may be born with a defective parathyroid gland that does not produce any hormone or some people may be born without the gland.
- Some forms of congenital hypoparathyroidism are accompanied by hormone deficiency in other glands.
- Decreased magnesium levels in the blood:
- Magnesium in normal levels is essential for the normal production of PTH.
- Low levels of magnesium reduce the functionality of the parathyroid glands, reducing the production of PTH.
- Radiation therapy for head and neck cancer:
- Radiation therapy to treat head or neck cancer damages the parathyroid glands and causes hypoparathyroidism.
What are the symptoms of hypoparathyroidism?
Hypoparathyroidism leads to calcium deficiency, so symptoms are mostly associated with low calcium levels, which may include:
- Seizures
- Dyspnea (difficulty breathing)
- Muscle ache or cramps in the legs, feet, lower back, or face
- Muscle spasms or twitching of the muscles, especially around the mouth, hands, arms, and throat
- Tingling, burning, or numbness in the fingertips, toes, and lips
- Arrhythmias (irregular heartbeats)
- Hypotension (low blood pressure)
- Laryngospasm (closing off of the upper airway)
- Patchy hair loss
- Dry, coarse skin
- Brittle nails
- Fatigue
- Anxiety
- Depression
- Confusion
- Memory problems
- Headache
- Painful menstruation
- Movement disorders such as tremors
- Cataracts
- Impaired formation of the teeth
- Constipation
- Nausea
- Diarrhea
How is hypoparathyroidism diagnosed?
Hypoparathyroidism diagnosis is primarily done by reviewing medical history and physical examination to find symptoms such as dry skin, muscle spasms, and hair loss.
Blood tests
The following blood results confirm hypoparathyroidism:
- Low blood calcium level
- Low parathyroid hormone level
- High blood phosphorus level
- Low blood magnesium level
Moreover, electrolyte, iron, and copper levels are evaluated to identify hypoparathyroidism and associated electrolyte abnormalities.
Urine test
- Test for evaluating electrolyte concentration in the urine is performed if blood work shows abnormal electrolyte levels.
Imaging
- Computer tomography or magnetic resonance imaging of the neck is performed to determine the presence of tumors or structural abnormalities close to the parathyroid gland.
- Bone density tests and X-rays are performed to determine the effect of low calcium levels on the bones.
- An electrocardiogram is performed to detect an abnormal heart rhythm.
Genetic and metabolic tests
- Based on your other indications and symptoms, the doctor may look for hypoparathyroidism causes, such as Kearns–Sayre syndrome or MELAS syndrome, because these illnesses are linked with issues in addition to hypoparathyroidism.
What are the treatment modalities for hypoparathyroidism?
Calcium and vitamin D supplements are used orally to treat hypoparathyroidism. Vitamin D supplements are required because vitamin D increases calcium absorption and removes excess phosphorus. Vitamin D promotes the release of calcium from the bone and aids in calcium absorption from the stomach and kidneys.
Calcium supplements are taken as oral tablets as maintenance therapy. Intravenous injections are given for quick rectification of hypocalcemia (low calcium) to prevent serious complications.
- Avoid phosphate-containing meals such as soda and other fizzy drinks because they draw calcium from your bones.
- Consume calcium-rich foods such as low-fat dairy products, dark green vegetables (collard greens and kale), and calcium-fortified foods (certain cereals and orange juices).
Man-made (synthetic) parathyroid hormone has been developed. However, it is not generally accessible and is presently undergoing long-term studies to determine its advantages and safety.