• Hypoparathyroidism

    (Underactive Parathyroid)

    Definition

    The parathyroid glands are four pea-sized glands. They are located next to the thyroid gland in the neck. The glands secrete the parathyroid hormone (PTH). PTH helps to regulate the level of calcium in the blood.
    In hypoparathyroidism, there is not enough PTH secreted. This causes low levels of calcium in the blood. Low blood calcium is known as hypocalcemia.
    Thyroid and Parathyroid Glands: Posterior (Back) View
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    Causes

    Hypoparathyroidism may be caused by:
    • Removal of the parathyroid glands
    • Damage to the parathyroid glands
    • Underlying autoimmune disorders
    • Absence of the parathyroid glands at birth
    • Genetics conditions, such as 22q11.2 deletion syndrome
    • Magnesium deficiency due to alcohol use disorder and/or malnutrition
    • Other causes, such as metal overload from iron, magnesium, or aluminium
    In some cases, a cause cannot be found.

    Risk Factors

    Factors that may increase your chance of hypoparathyroidism include:
    • Multiple autoimmune disorders
    • Thyroid or parathyroid surgery
    • Family history of hypoparathyroidism

    Symptoms

    Hypoparathyroidism does not always cause symptoms. If symptoms do develop, they may include:
    • Tingling around the mouth, fingers, and toes
    • Weakness
    • Muscle cramps or twitching
    • Abnormal heart rhythm
    • Excessive nervousness or anxiety
    • Difficulty with breathing due to spasm of breathing tubes
    • Mood swings
    • Loss of memory and confusion
    • Blurred vision due to cataracts
    • Thin, brittle nails
    • Dry and scaly skin
    • Seizures

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done.
    Your bodily fluids may be tested. This can be done with:
    • Blood tests
    • Urine test
    An electrocardiogram will be done to look for an abnormal heart beat.

    Treatment

    Treatment options include the following:

    Calcium and Vitamin D Supplementation

    Calcium and vitamin D will usually be taken indefinitely. They are often taken by mouth.
    Calcium may be given by injection. This is done when immediate symptom relief is needed.

    Parathyroid Hormone Replacement

    Recombinant human parathyroid hormon is FDA approved for treatment.
    May be given to patients that have high blood and urine calcium on the usual treatment.

    Prevention

    There are no current guidelines to prevent hypoparathyroidism.
    Some surgeons may move the parathyroid glands (autotransplant) before a total thyroidectomy to prevent damage.

    RESOURCES

    Hypoparathyroidism Association, Inc. https://www.hypopara.org

    National Organization for Rare Disorders http://www.rarediseases.org

    CANADIAN RESOURCES

    Canadian Society of Endocrinology & Metabolism http://www.endo-metab.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Definition of hypoparathyroidism and related disorders. The Hypoparathyroidism Association website. Available at: https://www.hypopara.org/about-hpth/definition.html. Accessed August 23, 2017.

    Hypoparathyroidism. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114796/Hypoparathyroidism. Updated June 27, 2017. Accessed August 23, 2017.

    Hypoparathyroidism. National Organization for Rare Disorders website. Available at: http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/703/viewFullReport. Updated April 2, 2014. Accessed August 23, 2017.

    De Sanctis V, Soliman A, Fiscina B. Hypoparathyroidism: from diagnosis to treatment. Curr Opin Endocrinol Diabetes Obes. 2012 Dec;19(6):435-42.

    Shoback D. Hypoparathyroidism. N Engl J Med 2008; 359:391-403.

    Moffett JM, Suliburk J. Parathyroid autotransplantation. Endocr Pract. 2011;17 Suppl 1:83-89.

    Thakker RV. Genetic developments in hypoparathyroidism. Lancet. 2001;357(9261):974-976.

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