Hypoparathyroidism is a rare condition that occurs when the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).
Everyone has four parathyroid glands, located near of behind the thyroid gland. Each small gland is the size of a grain of rice. The major function of PTH is to regulate the level of calcium in the body. It also controls the level of phosphorus and participates in the production of the active form of vitamin D. All of these activities are required to maintain calcium balance.
Having too little PTH causes low levels of calcium and high levels of phosphorus in the body. This condition may not cause any serious medical problems when caught early, but it does require lifelong monitoring and treatment.
Causes of hypoparatyhroidism include:
- injury to or removal of the parathyroid glands
- DiGeorge syndrome (a genetic disorder that affects development of certain body systems)
- genetics: individuals can be born without parathyroid glands or with glands that do not function properly
- autoimmune disease (when your immune system rejects parathyroid tissues)
- cancer radiation treatments
- low magnesium levels: magnesium is a mineral needed for PTH to be secreted by the parathyroid glands
Many of the symptoms of this condition are caused by low calcium levels. They can include:
- muscle aches or cramps
- tingling, burning, or numbness in fingertips, toes, and lips
- muscle spasms, especially around the mouth
- patchy hair loss
- dry skin
- brittle nails
- anxiety or depression
- painful menstruation
Your doctor will begin by reviewing your medical history, followed by a physical examination to check for symptoms such as dry skin, muscle spasms, and hair loss. To diagnose this condition in children, the doctor will also check for abnormal tooth development and delayed milestones. Your doctor will order blood tests to check the levels of calcium, phosphorus, magnesium, and PTH in your blood.
Additional tests include:
Your doctor may test your urine for calcium to determine if excess levels of calcium are being secreted in the urine.
This is a procedure that measures the electrical activity in your heart. The information from this test can tell your doctor if you have an abnormal heart rhythm, which can be caused by calcium deficiency.
X-Rays and Bone Density Tests
These imaging tests can help your doctor determine if low calcium levels have affected your bones.
Calcium and Mineral Restoration
Treatment for this condition is designed to help restore the proper levels of calcium and minerals in the body. Initial treatment involves taking calcium carbonate and vitamin D supplements in pill form. Vitamin D is given because it helps the body absorb calcium and eliminate phosphorus. The amount of calcium and vitamin D you need will be determined by your doctor. Your calcium, phosphorus, magnesium, and PTH levels will be monitored periodically to ensure that you are within the normal range.
Your doctor may suggest taking supplements throughout the day to help stabilize your calcium level. Most individuals need to take supplements for the rest of their lives to treat this condition.
If your calcium levels are life threatening or if you are experiencing troubling muscle spasms, intravenous (IV) calcium will be given. As the calcium goes directly into the bloodstream, symptoms will be relieved more quickly. Your doctor may also order diuretics (also called “water pills”) to help decrease the amount of calcium secreted in your urine.
A diet that is rich in calcium and low in phosphorus is suggested for individuals with hypoparathyroidism. Drinking six to eight glasses of water per day can also help ensure that your body does not lose necessary nutrients. Calcium-rich foods include:
- dark green leafy vegetables
- dairy products
- fortified breakfast cereals
- fortified orange juice
Certain phosphorus-rich foods can significantly decrease calcium levels, and should be avoided. These include:
- soft drinks
- red meat
- refined foods, like white bread and pasta
- trans fats, which can be found in baked goods
- coffee, alcohol, and tobacco
Always discuss dietary changes and supplements with your doctor to ensure that you get the amount of vitamins and nutrients you need.
Early diagnosis and treatment can significantly reduce the risk of complications from hypoparathyroidism. Complications due to low calcium levels may still occur, but can be improved with treatment. Reversible complications include:
- tetany: prolonged cramp like spasms in the hands and fingers
- malformed teeth
- heart arrhythmias (irregular heartbeat)
- paresthesias: tingling sensations in lips, tongue, fingers, and feet
If not diagnosed early, however, certain irreversible complications may occur, such as:
Your doctor will monitor levels of calcium and phosphorus through regular blood tests. Immediately following diagnosis, tests will be weekly or monthly. Once your condition is stabilized with treatment, blood testing will only happen twice a year. If there are any changes in calcium or phosphorus levels, your doctor will adjust the dosage of supplemental calcium accordingly.
Because hypoparathyroidism is a chronic condition, treatments and dietary changes will have to be maintained throughout your life. Most people can keep their symptoms under control with proper long-term treatment.