Hypoparathyroidism: Understanding Low Parathyroid Function

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Hypoparathyroidism is a rare condition where the parathyroid glands (four small endocrine glands located next to the thyroid gland) are underfunctioning. When they don’t function properly, the parathyroid glands produce too little parathyroid hormone, known as parathormone, or PTH.

A deficiency in parathyroid hormone results in low levels of calcium in the blood – known as hypocalcemia.

The job of parathyroid hormones is to keep blood calcium and phosphorous levels in the correct balance. Low levels of calcium and phosphorous can lead to problems with muscles, nerve endings, bones and skin.

What Causes Hypoparathyroidism?

Hypoparathyroidism has a number of causes:

  • Head or neck injury
  • Surgical injury, during head/neck surgery. Hypoparathyroidism is one of the more common complications after thyroid surgery for thyroid cancer, goiter, nodules, or hyperthyroidism. (Note: a percentage of post-surgical hypoparathyroidism resolves over time.)
  • Congenital hypoparathyroidism, when a baby is born with malfunctioning, malformed, or missing parathyroid glands
  • Extremely low magnesium can cause hypoparathyroidism, due to the fact that magnesium is needed for parathyroid hormone to be secreted by the parathyroid glands.
  • Hypoparathyroidism can be autoimmune – known as Autoimmune Hypoparathyroidism. In this case, antibodies attack the parathyroid tissue and the glands will then stop producing parathyroid hormone.
  • Sometimes, excessive radiation treatment for cancers in the head and neck can cause damage to the parathyroid glands.
  • Hemochromatosis and thalassemia, two conditions that cause iron overload
  • Wilson disease – a condition that can cause excess copper levels

Signs and Symptoms of Hypoparathyroidism

There are a number of signs and symptoms of hypoparathyroidism, including:

  • Dry hair, hair that breaks easily, hair loss
  • Brittle nails, ridges in nails
  • Dry, coarse or thick skin
  • Tingling in fingers/toes/lips – known as parathesia
  • Eye problems, especially cataracts
  • Muscle cramps
  • Muscle spasms
  • Pain in legs/feet/hands/face
  • Dental issues
  • Cataracts
  • Headaches
  • Memory loss
  • Anxiety/depression
  • Seizures
  • Fatigue

How Is Hypoparathyroidism Diagnosed?

A doctor will review your health and surgical history, and then complete a physical exam to check for symptoms. In children, a doctor will look for delayed milestones and abnormal tooth development. Blood tests will be taken to evaluate phosphorous, magnesium and parathyroid hormone levels. Other tests include:

  • Bone density tests and x-rays to determine if low calcium levels have affected the bones
  • A urinary calcium test, to look for elevated levels
  • An electrocardiogram (ECG) to look for an abnormal rhythm, which can be caused by a calcium deficiency

How Is Hypoparathyroidism Treated?

Treatment for hypoparathyroidism is with supplemental vitamin D and calcium carbonate. Vitamin D helps the body absorb calcium and get rid of the excess phosphorous. The amount of supplementation will be determined by the physician. The levels will then be periodically monitored to ensure they are in the normal range.

Typically, the supplements are taken throughout the day to help maintain therapeutic calcium levels. Taking all the pills at one time of the day does not help as the levels then go up quickly, then drop far too low.

Sometimes, if the calcium level is drastically low, IV calcium will be ordered. This is done to quickly get the calcium into the bloodstream, so that symptoms can be relieved quickly.

In some cases, patients may not be able to tolerate the amount of calcium and vitamin D needed to resolve hypoparathyroidism. A second-line treatment option is use of recombinant PTH, typically delivered via twice-a-day injections or a pump, similar to an insulin pump.

Sun exposure also helps Vitamin D levels. The recommended amount is 10-15 minutes of direct sunlight - at least twice a week. (Do not spend excessive time in the sun as this may increase your risk of skin cancer.)

Eating a diet rich in calcium and low in phosphorous is also a way to help treat hypoparathyroidism. Calcium rich foods include:

  • almonds
  • apricots
  • beans
  • cod liver oil
  • dairy products
  • dark green leafy vegetables (spinach/kale/broccoli)
  • fish (oysters/salmon)
  • fortified breakfast cereals
  • fortified orange juice
  • mushrooms
  • oats
  • prunes

Your doctor may recommend that you avoid these phosophorus-rich foods:

  • coffee
  • eggs
  • lunch meats
  • red meat
  • refined foods (white bread, pasta)
  • sausage
  • soft drinks
  • trans fats (found in baked goods make with shortening, snacks, fried foods, creamers, margarine)
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