Hypoparathyroidism: Symptoms, Diagnosis & Treatment Options

What is Hypoparathyroidism?

Hypoparathyroidism is a disorder characterised by deficient secretion or action of parathyroid hormone (PTH), resulting in low calcium (hypocalcaemia) and elevated phosphorus (hyperphosphataemia) levels in the blood. The parathyroid glands — typically four small glands located behind the thyroid — secrete PTH, which helps maintain normal blood calcium levels by stimulating the release of calcium from bones, increasing calcium absorption in the intestines and reducing calcium loss through the kidneys.

When the parathyroid glands are damaged, removed, or fail to function properly, PTH levels drop, disrupting the body's ability to regulate calcium balance. This results in hypocalcaemia, which can cause various symptoms related to nerve and muscle function.

Understanding Parathyroid Glands and Their Function

• The parathyroid glands are four small, pea-sized glands located behind the thyroid gland in the neck.
• They produce and secrete parathyroid hormone (PTH), which plays a vital role in regulating calcium and phosphorus levels in the blood.
• PTH helps maintain normal blood calcium levels by promoting calcium release from bones, enhancing calcium absorption in the intestines (indirectly through activation of vitamin D), and reducing calcium loss through the kidneys.
• Proper calcium balance is essential for various bodily functions, including muscle contraction, nerve signalling, and bone health.

How Hypoparathyroidism Affects Calcium Balance

• In hypoparathyroidism, the low PTH levels disrupt the body's ability to maintain normal blood calcium levels, leading to hypocalcaemia.
• Decreased calcium levels can cause various symptoms, such as tingling sensations, muscle cramps, and spasms.
• Simultaneously, phosphorus levels rise (hyperphosphataemia) due to reduced excretion by the kidneys, as PTH also regulates phosphorus balance.
• Prolonged low calcium levels can affect multiple systems, including bones, teeth, hair, skin, and neurological function.

Causes of Hypoparathyroidism

1. Surgical removal or damage: The most common cause of hypoparathyroidism is the inadvertent removal or damage of the parathyroid glands during head or neck surgeries, such as thyroidectomy or parathyroidectomy.
2. Autoimmune disorders: In some cases, the body's immune system mistakenly attacks and destroys the parathyroid glands, leading to hypoparathyroidism. This can occur in isolation or as part of a broader autoimmune disease condition, such as autoimmune polyglandular syndrome type 1 (APS-1).
3. Genetic disorders: According to the National Organisation for Rare Disorders, certain rare hereditary conditions, such as DiGeorge syndrome or familial isolated hypoparathyroidism, can cause the parathyroid glands to develop abnormally or function poorly.
4. Radiation therapy: Exposure to radiation in the neck or upper chest area, such as for thyroid or head and neck cancers, can damage the parathyroid glands and cause hypoparathyroidism.
5. Mineral imbalances: Severe magnesium deficiency can impair PTH production and function, resulting in hypoparathyroidism.
6. Idiopathic causes: In some cases, the exact hypoparathyroidism cause remains unknown (idiopathic hypoparathyroidism).

Symptoms of Hypoparathyroidism

• Tingling or numbness in the lips, fingers, and toes (paraesthesia)
• Muscle cramps and spasms, which may affect the face, hands, feet, or cause difficulty breathing
• Fatigue and weakness
• Abdominal pain and nausea
• Dry, coarse skin and brittle nails
• Coarse and brittle hair
• Dental problems, such as delayed tooth development and weak tooth enamel
• Abnormal heart rhythms (arrhythmias)
• Emotional changes, including anxiety, depression, and irritability
• Cataracts (clouding of the eye lens)
• Painful menstrual periods
• Seizures (in severe cases)

Early Warning Signs

• Tingling or "pins and needles" sensation in the lips, fingers, or toes
• Mild muscle cramps or twitching
• Unusual fatigue or weakness
• Subtle changes in mood or emotions

Diagnosis of Hypoparathyroidism

Diagnosing hypoparathyroidism involves a combination of clinical assessment and laboratory tests. Your doctor will consider your medical history, including any recent neck surgeries, family history of endocrine disorders, or autoimmune disease conditions. They will also perform a physical examination to evaluate your hypoparathyroidism symptoms. The diagnosis is confirmed by blood tests showing low calcium levels, high phosphorus levels, and inappropriately low or normal PTH levels.

Tests for Hypoparathyroidism Diagnosis

• Parathyroid Hormone (PTH), Intact assay
• Parathyroid Panel Test
• Calcium Profile
• Vitamin D Plus Profile
• Calcium Urine 24H

Treatment Options for Hypoparathyroidism

The primary goal of hypoparathyroidism treatment is to restore and maintain normal blood calcium and phosphorus levels, alleviating symptoms and preventing long-term complications.

Treatment options include:

1. Calcium supplements: Oral calcium supplements, such as calcium carbonate or calcium citrate, are prescribed to increase blood calcium levels and manage symptoms.
2. Activated vitamin D supplements: Calcitriol or alfacalcidol, active forms of vitamin D, are used to enhance calcium absorption in the intestines and help maintain normal calcium levels.
3. Thiazide diuretics: In select patients, thiazide diuretics may be used to reduce urinary calcium excretion and help maintain stable calcium levels, particularly in those with hypercalciuria.
4. Magnesium supplementation: If magnesium deficiency is present, magnesium supplements may be necessary to support proper PTH function and calcium regulation.
5. Recombinant human parathyroid hormone (rhPTH 1-84): In patients who do not achieve adequate control with standard therapy, rhPTH 1-84 may be used to replace missing PTH and maintain calcium balance to mimic the action of natural PTH and regulate calcium levels.
6. Dietary adjustments: A diet rich in calcium and magnesium, while limiting phosphorus-rich foods such as dairy, red meat, and processed foods, supports mineral balance.

Managing Hypoparathyroidism Long-Term

Managing hypoparathyroidism is a lifelong process that involves regular monitoring, medication adjustments, and lifestyle modifications. The goal is to maintain stable blood calcium and phosphorus levels, prevent complications, and ensure optimal quality of life. Patients need to work closely with their healthcare team, including an endocrinologist, to develop an individualised treatment plan.

Monitoring and Follow-up Care

• Periodic blood tests to monitor calcium, phosphorus, and PTH levels
• Assessment of kidney function through urine calcium and creatinine tests, as well as renal imaging when necessary
• Monitoring for symptoms of hypocalcaemia or hypercalcaemia, such as neurological and muscular signs
• Regular eye examinations to check for cataracts
• Dental check-ups, especially for children, to assess tooth development and enamel health
• Adjustment of supplement dosages based on laboratory results and clinical response
• Lifelong follow-up with an endocrinologist to ensure optimal management

Complications and Prevention

Complications:

• Kidney stones or nephrocalcinosis (calcium deposits in the kidneys) may occur due to excessive calcium and vitamin D supplementation or prolonged imbalance of calcium and phosphorus levels
• Seizures and cardiac arrhythmias resulting from severe hypocalcaemia
• Cataracts, a clouding of the eye lens
• Dental abnormalities, particularly in children
• Neuropsychiatric symptoms, such as depression, anxiety, or cognitive impairment

Prevention:

• Careful monitoring of calcium and phosphorus levels, with appropriate adjustments to supplement dosages
• Early diagnosis and prompt initiation of treatment to prevent long-term complications
• Patient education on recognizing symptoms of hypocalcaemia or hypercalcaemia and seeking timely medical attention

Prognosis and Living with Hypoparathyroidism

With appropriate lifelong treatment and regular monitoring, most people with hypoparathyroidism can lead normal, active lives. However, untreated or poorly managed hypoparathyroidism can lead to significant complications and reduced quality of life. Patients need to work closely with their healthcare team, adhere to their treatment plan, and actively participate in their care. Maintaining a balanced diet, staying physically active, and managing stress can also contribute to better overall health and well-being.

Metropolis Healthcare, a leading diagnostic laboratory chain with a presence in over 750 towns and cities across India, is committed to providing reliable, patient-centric testing services to support the diagnosis and management of hypoparathyroidism. With a robust network of more than 220 laboratories, 4,600+ service centres, and over 10,000 touchpoints, Metropolis Healthcare offers convenient access to advanced testing. Our commitment to technological innovation, accuracy, and trust has set new benchmarks in the diagnostic industry, enabling healthcare providers to deliver timely, personalised care to patients.

FAQs

Can hypoparathyroidism be cured?

Most cases of hypoparathyroidism cannot be cured, especially when caused by surgical removal or autoimmune destruction of the parathyroid glands. Lifelong treatment is usually necessary, although genetic or transient forms may resolve in rare cases.

Is hypoparathyroidism life-threatening?

Untreated or poorly managed hypoparathyroidism can be life-threatening due to the risk of severe complications, such as seizures, cardiac arrhythmias, and laryngospasm. However, with proper treatment and monitoring, the risk of life-threatening events is greatly reduced, and patients can lead normal, healthy lives.

What is the life expectancy with hypoparathyroidism?

With adequate treatment and regular monitoring, the life expectancy for individuals with hypoparathyroidism is generally normal. However, quality of life may be affected by the burden of daily medication, the need for frequent medical check-ups, and the potential for long-term complications if the condition is not well-controlled.

Can hypoparathyroidism be reversed?

Hypoparathyroidism resulting from reversible causes (such as magnesium deficiency) may improve if the underlying issue is corrected. Permanent cases due to gland removal or genetic causes cannot be reversed.

Is hypoparathyroidism hereditary?

While most cases of hypoparathyroidism are acquired due to surgery, autoimmune disorders, or other non-genetic causes, some forms of the disorder can be hereditary. Genetic conditions such as familial isolated hypoparathyroidism, DiGeorge syndrome, and autoimmune polyglandular syndrome type 1 (APS-1) can cause hypoparathyroidism.

How is hypoparathyroidism different from hyperparathyroidism?

While hypoparathyroidism is characterised by low PTH levels, low blood calcium, and high blood phosphorus, hyperparathyroidism presents with high PTH, high calcium, and low phosphorus. Symptoms also differ, with hypoparathyroidism causing muscle cramps, tingling, and seizures, while hyperparathyroidism may lead to bone pain, kidney stones, and abdominal pain. The causes are distinct as well, with hypoparathyroidism often resulting from surgery, autoimmune diseases, or genetic factors, and hyperparathyroidism commonly caused by parathyroid adenomas or hyperplasia.

References
1.    https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/symptoms-causes/syc-20355375
2.    https://my.clevelandclinic.org/health/diseases/22672-hypoparathyroidism
3.    https://rarediseases.org/rare-diseases/hypoparathyroidism/
4.    https://www.ncbi.nlm.nih.gov/books/NBK441899/
5.    https://www.nhs.uk/conditions/hypoparathyroidism/