Hypoparathyroidism

What is hypoparathyroidism?

Hypoparathyroidism is a condition in the parathyroid glands do not produce enough parathyroid hormone. This leads to low levels of calcium in the blood, which can cause both short-term and long-term symptoms. Causes of hypoparathyroidism include surgery or radiation to the neck, autoimmune damage to the parathyroid glands, abnormal development of the parathyroid glands, and low levels of magnesium in the blood.

Short-term symptoms of hypoparathyroidism include numbness around the mouth, tingling in the hands and feet, muscle cramps or spasms, or feeling anxious or depressed. Long-term symptoms include movement disorders, confusion and forgetfulness, blurry vision, and changes to the bones, teeth, skin, hair, and/or nails.

Hypoparathyroidism is treated with oral or IV medications to increase calcium levels in the blood. A newer medication to treat hypoparathyroidism is PTH 1-84, which mimics the body's natural parathyroid hormone.

You should seek immediate medical care at an ER since any symptoms caused by a low calcium can be very serious. Treatment depends on how low (if low at all) your calcium levels are.

Symptoms of hypoparathyroidism

Hypoparathyroidism can cause both short-term and long-term symptoms. The diagnosis is made by measuring levels of parathyroid hormone and calcium in the blood.

Short-term symptoms

Symptoms that can be described as short-term include the following.

• Numbness around the mouth: Mild hypoparathyroidism can cause numbness around the mouth. This occurs due to a low calcium level in the blood.
• Tingling in the hands and feet: Mild hypoparathyroidism can also cause tingling (paresthesia) in the hands and feet, also due to a low calcium level in the blood.
• Muscle cramps or spasms: Low calcium levels in the blood can also cause muscle cramps or spasms throughout the body. This can be detected with a number of physical exam findings, including Chvostek's sign (tapping on the cheek causes the upper lip to twitch) and Trousseau's sign (inflating a blood pressure cuff over the arm for three minutes causes the hand to contract).
• Trouble swallowing or breathing: Severe hypoparathyroidism can cause trouble swallowing or breathing because the muscles in the throat close up.
• Seizures: Severe hypoparathyroidism can also cause seizures or convulsions. This is due to a very low calcium level in the blood.
• Feeling irritable, anxious, or depressed: Some people with hypoparathyroidism can feel suddenly irritable, anxious, or depressed.
• Feeling a fluttering in the heart or chest discomfort: Severe hypoparathyroidism can cause changes to the heart rhythm, which can cause a fluttering feeling (palpitations) or discomfort in the chest.

Long-term symptoms

Symptoms that can be described as long-term that develop and persist over time include the following.

• Movement disorders: Some people with longstanding hypoparathyroidism can develop movement disorders. These can include a number of symptoms, including flailing of the arms or legs, writhing movements, muscle spasms, resting tremors, or slow shuffling movements with walking.
• Confusion and forgetfulness: Some people with longstanding hypoparathyroidism can develop dementia which causes long-term confusion and forgetfulness.
• Blurry vision or eye irritation: Some people can develop cataracts over time, which is when the lens of the eye becomes cloudy. This will cause blurry vision and glare at night. Some people can also develop an inflammation of the eye surface, which can cause their eye to turn red and irritated.
• Abnormal teeth: People who have hypoparathyroidism as a child when teeth are still developing can have abnormal teeth development, resulting in small or missing teeth.
• Bone changes: Some people with hypoparathyroidism can develop thicker bones. In children whose skulls are still developing, this can result in abnormal face shapes.
• Skin, hair, and nail changes: People who have hypoparathyroidism for a long time can develop dry, puffy skin, patchy hair loss, or brittle nails.

Causes of hypoparathyroidism

Hypoparathyroidism is when the parathyroid glands don't produce enough parathyroid hormone. Parathyroid hormone helps to increase levels of calcium in the body by increasing its release from the bones, increasing its absorption from the gut, and decreasing its excretion in the urine. Therefore, hypoparathyroidism will result in low calcium levels, which can cause a variety of symptoms. Causes of hypoparathyroidism include:

Surgery in the neck that damages the parathyroid glands

Surgery in the neck area, involving the thyroid gland or parathyroid gland or surgery to remove cancer in the neck, can damage the parathyroid glands. This can cause either temporary or permanent hypoparathyroidism, depending on the extent of the damage. Neck surgery is the cause of about 75 percent of cases of hypoparathyroidism. After surgeries to remove the thyroid gland, temporary hypoparathyroidism has been reported to occur in approximately 25 to 30 percent of cases.

Abnormal immune system that reduces parathyroid levels

Some people have a condition in which their immune system functions abnormally and attacks their own parathyroid glands. This can cause permanent damage to the parathyroid glands, resulting in hypoparathyroidism. In some cases, this can be associated with a syndrome called "autoimmune polyendocrine syndrome type 1," in which the immune system attacks multiple hormone-producing organs in the body. Other people may have an abnormal immune system that reduces production of parathyroid hormone but does not damage the glands. In these cases, the hypoparathyroidism is usually temporary and may improve on its own.

Abnormal development of parathyroid glands

Some people have genetic conditions that cause the parathyroid glands to develop abnormally. These abnormal parathyroid glands will not secrete enough parathyroid hormone, resulting in hypoparathyroidism. One example is DiGeorge syndrome, which is a common cause of hypoparathyroidism in children.

Low levels of magnesium in the blood

Low levels of magnesium in the blood can also cause hypoparathyroidism. This can occur because magnesium is required for the parathyroid glands to secrete parathyroid hormone.

Radiation treatment to the neck

In rare cases, people who receive radiation treatment to the neck (such as for cancer) may also damage their parathyroid glands, resulting in hypoparathyroidism.

Treatment options and prevention for hypoparathyroidism

Hypoparathyroidism is a chronic condition. If the parathyroid glands have been permanently damaged, there is no way to cure the disease, so treatments focus on maintaining calcium levels to reduce and prevent symptoms.

Oral medications

If your hypoparathyroidism is not severe, your physician can prescribe pills to increase your calcium levels and reduce the symptoms of hypoparathyroidism. These include calcium pills (calcium carbonate, calcium citrate, or calcium lactate) and vitamin D pills (calcitriol or alfacalcidol), which also help to increase calcium levels. Your physician may need to check the levels of calcium in your blood and urine every week at first until you reach a steady level of calcium in the blood. These medications may need to be taken life-long if the hypoparathyroidism is permanent.

Medications via IV

If your hypoparathyroidism is severe, you may be treated in the hospital with medications given through an IV to increase your calcium levels. This will prevent any life-threatening symptoms until your calcium levels become close to normal. At that point, your physician may switch you to oral medications to maintain calcium levels.

Medications via injection

Some people with hypoparathyroidism may benefit from using a medication that is injected into the skin, known as PTH 1-84 (Natpara), which was approved by the FDA in 2015. This medication mimics the body's natural parathyroid hormone. Using this medication can reduce the amount of calcium and vitamin D pills that you may have to take. In one study, using this medication reduced the amount of calcium and vitamin D supplements required by about 50 percent. However, this medication may be more expensive than the pills.

When to seek further consultation for hypoparathyroidism

You should see your physician if you experience numbness around the mouth or tingling in the hands and feet. Your physician can check the levels of parathyroid hormone and calcium in your blood to see if you have hypoparathyroidism and would benefit from treatment. It is especially important to see your physician if you experience trouble swallowing or breathing, seizures, or chest discomfort, as this may suggest that you have severe hypoparathyroidism.

If you undergo any surgeries in the neck region

You are at risk of developing hypoparathyroidism after your surgery. Therefore, your physician should check the levels of calcium in your blood both before and after your surgery in case you develop hypoparathyroidism and need treatment.