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Hypoparathyroidism

Parathyroid-related hypocalcemia

 

Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).

Causes

 

There are 4 tiny parathyroid glands in the neck, located near or attached to the back side of the thyroid gland.

The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone.

Hypoparathyroidism occurs when the glands produce too little PTH. The blood calcium level falls, and the phosphorus level rises.

The most common cause of hypoparathyroidism is injury to the parathyroid glands during thyroid or neck surgery. It may also be caused by any of the following:

  • Radioactive iodine treatment for hyperthyroidism
  • Very low magnesium level in the blood
  • Autoimmune attack on the parathyroid glands

DiGeorge syndrome is a childhood disease in which hypoparathyroidism occurs because all the parathyroid glands are missing at birth. This disease includes other health problems besides hypoparathyroidism.

Familial hypoparathyroidism occurs with other endocrine diseases such as adrenal insufficiency in a syndrome called type I polyglandular autoimmune syndrome (PGA I).

 

Symptoms

 

Symptoms may include any of the following:

  • Abdominal pain
  • Brittle nails
  • Cataracts
  • Calcium deposits in some tissues
  • Decreased consciousness
  • Dry hair
  • Dry, scaly skin
  • Muscle cramps
  • Muscle spasms called tetany (can affect the larynx, causing breathing difficulties)
  • Pain in the face, legs, and feet
  • Painful menstruation
  • Seizures
  • Teeth that do not grow in on time, or at all
  • Tingling lips, fingers, and toes
  • Weakened tooth enamel (in children)

 

Exams and Tests

 

The health care provider will do a physical exam and ask about symptoms.

Tests that will be done include:

  • PTH blood test
  • Calcium blood test
  • Magnesium
  • 24-hour urine test

Other tests that may be ordered include:

  • ECG to check for an abnormal heart rhythm
  • CT scan to check for calcium deposits in the brain

 

Treatment

 

The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body.

Treatment involves calcium carbonate and vitamin D supplements. These usually must be taken for life. Blood levels are measured regularly to make sure that the dose is correct. A high-calcium, low-phosphorous diet is recommended.

Injections of PTH may be recommended for some people. Your doctor can tell you if this medicine is right for you.

People who have life-threatening attacks of low calcium levels or prolonged muscle contractions are given calcium through a vein (IV). Precautions are taken to prevent seizures or larynx spasms. The heart is monitored for abnormal rhythms until the person is stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth.

 

Outlook (Prognosis)

 

The outcome is likely to be good if the diagnosis is made early. But changes in the teeth, cataracts, and brain calcifications cannot be reversed in children who have undiagnosed hypoparathyroidism during development.

 

Possible Complications

 

Hypoparathyroidism in children may lead to poor growth, abnormal teeth, and slow mental development.

Too much treatment with vitamin D and calcium can cause high blood calcium (hypercalcemia) or high urine calcium (hypercalciuria). Excess treatment may sometimes interfere with kidney function, or even cause kidney failure.

Hypoparathyroidism increases the risk of:

  • Addison disease (only if the cause is autoimmune)
  • Cataracts
  • Parkinson disease
  • Pernicious anemia (only if the cause is autoimmune)

 

When to Contact a Medical Professional

 

Call your provider if you develop any symptoms of hypoparathyroidism.

Seizures or breathing problems are an emergency. Call 911 or your local emergency number right away.

 

 

References

Clarke BL, Brown EM, Collins MT, et al. Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab. 2016;101(6):2284-2299. PMID: 26943720 www.ncbi.nlm.nih.gov/pubmed/26943720.

Darr EA, Sritharan N, Pellitteri PK, Sofferman RA, Randolph GW. Management of parathyroid disorders. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 124.

Thakker RV. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Parathyroid glands

    Parathyroid glands - illustration

    The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce pararthyroid hormone (PTH). Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.

    Parathyroid glands

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Parathyroid glands

      Parathyroid glands - illustration

      The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce pararthyroid hormone (PTH). Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.

      Parathyroid glands

      illustration

    Tests for Hypoparathyroidism

     

       

      Review Date: 5/2/2016

      Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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