How Hypoparathyroidism Is Diagnosed

Hypoparathyroidism occurs when one or more of the four parathyroid glands is underactive. Each of these glands is around the size of a rice grain. They are located in your neck, next to your thyroid gland.

If these glands become underactive, they cannot make enough parathyroid hormone to balance out the calcium and phosphorus in your body.

The goal of treatment is to relieve symptoms of the condition and normalize calcium and phosphorus. But before any treatment can be recommended, a proper diagnosis needs to be made.

This article will discuss how hypoparathyroidism is diagnosed, including recognizing the signs and symptoms, physical examination, lab work, imaging, and ruling out other conditions that cause similar symptoms.

Self-Checks/At-Home Testing

There are no self-exams or home testing methods to help determine hypoparathyroidism. However, knowing the signs and symptoms of the condition and communicating those to your doctor can increase your chance of getting a timely and appropriate diagnosis.

With hypoparathyroidism, low production of parathyroid hormones leads to hypocalcemia, a condition in which the calcium in the blood decreases, and hyperphosphatemia in which serum phosphorous increases.

The low levels of parathyroid hormone disrupt the balance between calcium and phosphorus, and the low levels of calcium contribute to the symptoms of hypoparathyroidism.

Calcium is necessary to supply the body with the energy needed for normal muscle contraction and nervous system function. Symptoms of hypoparathyroidism are related to dysfunction of muscles and nerves and are due to hypocalcemia.

The main symptoms of hypoparathyroidism are:

• Tingling or burning (pins and needles feeling) of the lips, hands, fingers, and toes
• Tetany (severe muscle spasms)
• Dry and/or thinning hair
• Dry skin
• Brittle nails
• Cataracts (the clouding of the lens of the eye)
• Headaches
• Twitching and cramping of muscles of the face, hands, arms, legs, and feet
• Yeast infections of the nails, skin, and mouth
• Low magnesium levels (magnesium has a role in regulating parathyroid hormone)
• Brain fog

Severe signs or complications of the condition include:

• Impaired kidney function
• Seizures that are the result of calcium deposits on the brain
• Cardiac arrhythmias that might lead to fainting
• Intellectual disability
• Voice hoarseness due to laryngospasms (muscular spasms of the larynx)
• Wheezing and dyspnea (difficulty breathing) due to bronchospasms (spasms of the bronchial tubes)

The symptoms of hypoparathyroidism may resemble symptoms of other conditions. Always see your healthcare professional for a correct diagnosis.

Physical Examination

Your healthcare professional will ask for your medical history and a report of the symptoms you have noted and when they started. They will also do a physical examination.

Your doctor will want to know what symptoms you are experiencing, including brain fog, fatigue, and getting tired easily. They will also ask you about any symptoms of anxiety or depression.

You might be asked if you think you have had any seizures, involuntary muscle jerks, twitching, and new-onset seizures, which are related to cerebral hypocalcemia. Cerebral hypocalcemia refers to calcium deposits on the brain that can cause neurological (concerning the brain and nervous system) or psychological (concerning a person's mental and emotional state) symptoms.

Symptoms might also include confusion, memory problems, delirium (confusion), hallucinations, and depression. These symptoms will resolve once calcium levels are restored.

Also report any breathing difficulties as hypoparathyroidism has been linked to heart-related symptoms and conditions, including acute cardiomyopathy (the heart muscle is weakened) and congestive heart failure (the heart can't pump enough blood). This is because low calcium and low parathyroid hormone decrease the ability of the heart to contract and circulate blood.

When signs of low calcium are seen, neuromuscular hyperexcitability testing may be done as part of the physical examination. This involves checking for Chvostek’s and Trousseau’s signs.

A Chvostek’s sign is produced by tapping the facial nerve at the front of the ear. If there is a neurological response, the facial muscles on the same side will twitch and cause contractions from the upper lip to the nose and then to the entire half of the face. How far the contraction extends will depend on the severity of the hypoparathyroidism.

A Trousseau’s sign is produced by placing a blood pressure cuff around the arm and inflating the cuff to more than systolic pressure (the high number of your blood pressure reading) and holding the position for three minutes. This will block the brachial artery, leading to hyperexcitability of the muscles from hypocalcemia. There will also be painful bending of the wrists and the finger joints.

Labs and Tests

If your doctor suspects that hypoparathyroidism and its related conditions are causing your symptoms, they will recommend blood work.

Your doctor will want to request blood to check for:

• Calcium levels
• Parathyroid hormone levels
• Phosphorus levels
• Magnesium levels      

Your urine might also be checked to determine if your body is expelling too much calcium.

Imaging

Your doctor might request imaging studies if the doctor suspects hypoparathyroidism symptoms are severe and calcium levels are dangerously low.

Radiology might reveal increased bone density, or bone thickening, especially of the spine. X-rays of the pelvis might reveal damage to the spine and nearby joints and soft tissues, called spondyloarthropathic changes. These are a sign of long-standing hyperparathyroidism.

If dental imaging is done, it might reveal tooth enamel and root abnormalities.

Computed tomography (CT) scans of the brain might show bilateral basal ganglia calcifications. This is a very rare condition in which calcium builds upon the brain in the basal ganglia, the part of the brain responsible for movement. Other parts of the brain can also be affected by calcium buildup.

Differential Diagnosis 

A differential diagnosis is a process of differentiating between two or more conditions that have similar symptoms. Many different conditions cause similar symptoms to hypoparathyroidism.

Differential diagnoses of hypoparathyroidism include:

• Infiltrative conditions like Wilson’s disease, a rare inherited disorder that causes copper to accumulate in your liver, brain, and other vital organs
• Autoimmune diseases like autoimmune polyendocrine syndrome type 1, an inherited autoimmune condition that affects many of the body's organs
• Genetic disorders, such as DiGeorge syndrome, a condition in which a person is born without parathyroid glands
• Vitamin deficiencies, including hypomagnesemia (low magnesium), vitamin D deficiency, or vitamin D hereditary sensitivity
• Pseudohypoparathyroidism, a hereditary disorder characterized by an inadequate response to the parathyroid hormone
• Pseudopseudohypoparathyroidism, an inherited condition that causes short stature, round face, and short hand bones

To ensure a correct diagnosis, your doctor will order additional testing (usually blood work) to rule out any of the above possible causes. This is often done when preliminary testing methods can’t confirm a specific diagnosis.

Summary

Hypoparathyroidism is a condition characterized by parathyroid hormone deficiency. It is diagnosed using different methods. Confirming a diagnosis might include recognition of the signs and symptoms, a physical examination, lab work to include blood and urine tests, and imaging in order to confirm hypoparathyroidism and rule out other conditions that might explain symptoms. 

A Word From Verywell

Hypoparathyroidism is a lifelong condition, but it is treatable and manageable. There are also steps you can take to make living with the condition easier.

This includes taking calcium supplements and getting calcium from your diet, drinking plenty of water to make it easier for your body to absorb vitamins and minerals, and seeing a dentist regularly to get ahead of any dental problems related to hypocalcemia.

It will be important to get your calcium and parathyroid hormone levels checked regularly. Make sure you attend all follow-up appointments and keep up with the blood work schedule your doctor has set.