Hypoparathyroidism

What causes hypoparathyroidism?

Your parathyroid glands are four pea-sized glands located in your neck that make parathyroid hormone (PTH). They play an important role in bone development and control the amount of calcium in the blood. You can get hypoparathyroidism when you have too little PTH. This can happen if your parathyroid glands get damaged during surgery on your thyroid gland, throat, or neck. Sometimes one or more parathyroid glands are removed if they’re making too much PTH. Hypoparathyroidism also can be hereditary (runs in families). Other causes include:

• Autoimmune disease (when your body’s defense system attacks your own cells)
• Radiation therapy to your head or neck (e.g. as part of therapy for cancer) 
• Low levels of magnesium (a mineral) in the blood
• Damage of parathyroid glands due to inflammatory disorders (e.g. Sarcoidosis, Amyloidosis)
• Mineral buildup (copper or iron)
• Transiently  due to severe illness

What are the symptoms of hypoparathyroidism?

Common symptoms include:

• Muscle spasms, cramps, and/or pain in your legs, feet, stomach, or face
• Weakness
• Hair loss
• Dry hair and dry skin
• Tingling in your fingers, toes, and lips
• Pain with menstrual periods
• Headaches
• Memory problems
• Depression

Definitions

Parathyroid hormone (PTH)

The hormone made by your parathyroid glands. When blood calcium falls too low, PTH brings it back to normal by moving calcium from the bones, kidneys, and intestines into the blood.

Calcium

A mineral stored in your bones where it builds and maintains bone strength. It is also found in every part of the body. It helps muscles contract, helps nerves and the brain work properly, and helps regulate your heart rhythm and blood pressure.

Phosphorus

 A mineral found in all cells but stored mostly in your bones. It helps your body use food for energy. It also helps your kidneys, muscles, heart, and nerves work properly.

Vitamin D

 A hormone that helps your body absorb calcium from food and helps keep blood calcium levels in the normal range.

What health problems can hypoparathyroidism cause?

When children have hypoparathyroidism, they might grow poorly, have tooth problems such as delayed tooth development or a lot of cavities, and have slow mental development.

In adults, hypoparathyroidism can lead to kidney problems (such as kidney stones, kidney failure), heart problems, and calcium deposits in the brain. Calcium in the brain can cause tremors, slowed movement, balance problems, and seizures.

Hypoparathyroidism can be linked to other health problems, such as cataracts, Addison disease (problems with your adrenal glands), and pernicious anemia (low vitamin B12 levels).

Calcium requirements increase in pregnancy to meet the needs of the developing baby, mainly during the 3rd trimester. Hypoparathyroidism during pregnancy can increase the risk of  pPreterm labor or miscarriage in the mother and  respiratory distress (difficulty to breath) in the baby. 

How is hypoparathyroidism diagnosed?

Your doctor will do a blood test to check levels of calcium, phosphorus, magnesium, and PTH. You also might have a urine test to show how much calcium you are losing in your urine.

What is the treatment for hypoparathyroidism?

You will take calcium and vitamin D supplements to keep your blood calcium levels normal. Depending on the cause of your hypoparathyroidism, you may need to take the supplements for the rest of your life. PTH replacement therapy is also available in injectable form. Your doctor may prescribe PTH therapy if your calcium level in the blood does not normalize or you continue having symptoms, despite taking large doses of calcium and vitamin D supplements.  Injecting PTH may decrease the need to take too many calcium and vitamin D supplements. Your doctor might also give you medicines, such as diuretics (water pills) to prevent too much calcium from leaving your body in your urine. Your doctor will check your blood levels regularly.

During pregnancy your doctor will closely monitor your calcium, phosphorous, magnesium levels and kidney function.  

If your blood calcium level becomes extremely low, it can be dangerous for your health. Then you will be given calcium through your veins (IV). Your heart will be checked to make sure your heart rate and rhythm are normal. and your heart will be checked to make sure it's OK. Once your calcium level is normal, you can go back to taking oral supplements.

You might need to follow a diet high in calcium and low in phosphorus. A registered dietitian can help you plan a special diet.

• Good Sources of Calcium: Milk, yogurt, cheese, collard greens, and foods with added calcium, such as cereal and soy drinks.
• Good Sources of Vitamin D: Salmon, shrimp, and milk with vitamin D. Vitamin D is also made in your skin when you spend time in the sun.
• Foods High in Phosphorus (to avoid): Protein foods such as meat, milk, hard cheeses, whole grains, dried peas and beans, nuts, and chocolate.

Questions to ask your doctor

• What caused my hypoparathyroidism?
• What tests do I need?
• What are my options for treatment?
• What are the risks and benefits of each treatment option?
• How long will I need treatment?
• How often will I need check-ups?
• How to take care of myself during pregnancy when I have hypoparathyroidism? 
• Should I see an endocrinologist?
• Should I see a registered dietitian?