Hypoparathyroidism

Overview – Hypoparathyroidism is the condition wherein the parathyroid glands produce an abnormally low level of parathyroid hormone (parathormone). The parathyroid hormone helps maintain an appropriate balance of calcium in the blood. The low levels of parathyroid hormone lead to low calcium levels.

Each parathyroid gland is about the size of a grain of rice and lies just behind the thyroid glands in the neck.
 

Symptoms of hypoparathyroidism –

  • Twitching of muscles
  • Weakness
  • Hair loss
  • Brittle nails
  • Depression or anxiety
  • Muscle aches or cramps
  • Menstrual problems
  • Cataracts
  • Dental problems 

Causes of hypoparathyroidism –

  • Post-surgical – Hypoparathyroidism can occur after thyroid, parathyroid, or radical neck surgery for head and neck cancer. The low parathyroid hormone level may be transient, permanent, or even intermittent.
  • Autoimmune disease – Hypoparathyroidism may be due to immune-mediated destruction of parathyroid glands.
  • Genetic disorders – Hypoparathyroidism may be due to defects associated with abnormal parathyroid development. DiGeorge syndrome and related disorders, HDR syndrome, Sanjad-Sakati and Kenny-Caffey syndromes.
  • Extensive radiation of face and neck.
  • Low levels of magnesium may result in hypoparathyroidism.
  • Storage or infiltrative diseases of the parathyroid glands such as hemochromatosis, Wilson’s disease, granulomas, or metastatic cancer.
     

Complications of hypoparathyroidism –

  • Tetany – The hallmark of acute low calcium levels is tetany. Tetany is cramp-like painful spasms of hands and fingers. It is also characterized by spasms of the muscles of face, throat or arms. The spasms of the muscles of the throat can interfere with breathing.
  • There are tingling sensations or pins and needles feelings in lips, tongue, fingers, and toes.
  • Basal ganglia calcifications are a manifestation of longstanding hypoparathyroidism. This can lead to balance problems and dementia.
  • Loss of consciousness with convulsions.
  • Heart problems such as arrhythmias, heart failure.
  • Hypoparathyroidism can cause defective enamel and root formation, and abraded carious teeth.
  • Impaired kidney function.
  • Stunted growth and slow mental development in children.
     

Diagnosis of hypoparathyroidism –

  • Diagnosis of hypoparathyroidism is made with physical examination and blood tests that show low calcium level, low parathormone level, high phosphorous level, and low magnesium level.
  • A urine test may be done to determine whether your body is excreting too much calcium.
     

Lifestyle management of hypoparathyroidism –

  • Follow the diet recommended by your doctor. Your doctor may advise a diet rich in calcium and low in phosphorous.
  • Visit your dentist regularly.
     

Medical management –

  • Acute, symptomatic postsurgical hypoparathyroidism are initially treated with intravenous calcium plus oral calcitriol supplementation.
  • The initial treatment of patients with long-standing hypoparathyroidism is calcium carbonate and vitamin D supplementation.
  • Recombinant human parathormone may be used in some people.

 

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