Download Hypoparathyroidism

Page 1 of 5
View this article online at: patient.info/health/hypoparathyroidism-leaflet
Hypoparathyroidism
Hypoparathyroidism occurs when too little parathyroid hormone is released by the parathyroid
glands, or the parathyroid hormone that is released does not work properly. Hypoparathyroidism
leads to low levels of calcium in the blood, which can cause a number of different symptoms. The
most common are muscle cramps, pain and twitching. Hypoparathyroidism can be successfully
treated with calcium and vitamin D supplements but regular blood test monitoring is needed.
What is hypoparathyroidism?
The four parathyroid glands are small, pea-sized glands, located
in the neck just behind the butterfly-shaped thyroid gland. Two
parathyroid glands lie behind each wing of the thyroid gland.
The parathyroid glands release a chemical (hormone) called
parathyroid hormone. This hormone helps to control the levels of
two salts in the body: calcium and phosphorus.
Hypoparathyroidism occurs when either:
The parathyroid glands do not release enough
parathyroid hormone, or
The parathyroid hormone that is released does not
work properly.
The resulting low level of active parathyroid hormone causes the
calcium level in the blood to fall and the phosphate level to rise.
Why does the body need calcium and phosphorus?
Calcium and phosphorus combine to make calcium phosphate in the body. This is the main material that gives
hardness and strength to bones and teeth. Calcium is also needed as part of the complex mechanism that helps
blood to clot after an injury. It is also required for muscles and nerves to work properly. Phosphorus works with
calcium to do these jobs. Phosphorus is also needed for the production of energy within the body.
Who gets hypoparathyroidism?
Hypoparathyroidism is rare. Men and women are equally likely to have the problem. The age that someone may
develop hypoparathyroidism depends on its cause.
What causes hypoparathyroidism?
Hypoparathyroidism can be:
Something that develops in childhood or adult life (acquired).
Short-lived (transient).
Something that someone is born with (congenital).
Passed on through your genes, from your relatives (inherited).
Page 2 of 5
Acquired hypoparathyroidism
The common cause of acquired hypoparathyroidism is after surgery to the neck. For example, during surgery on
the thyroid gland, the parathyroid glands may be accidentally damaged or removed. Sometimes the parathyroid
glands are removed because of potential cancer, or as a treatment for overactive parathyroid glands.
Radiotherapy treatment (because of a cancer in the neck or the chest) can damage the parathyroid glands and
make them underactive. Certain medicines used in the treatment of cancers can do the same.
The parathyroid glands can also become replaced and destroyed by cancer cells, spreading from cancer
elsewhere in the body. This causes a reduction in parathyroid hormone release and hypoparathyroidism.
Acquired hypoparathyroidism can also occur due to an acquired autoimmune condition. Auto-antibodies may start
attacking the cells of the parathyroid glands and destroy them, as described below.
Transient hypoparathyroidism
This occurs most commonly in babies who are born too soon (prematurely). It can also occur in otherwise
healthy babies born at the normal time. Parathyroid hormone is there in the glands but isn't released normally
after the baby is born. It is eventually released and all returns to normal.
Transient hypoparathyroidism can also affect babies of mothers who have diabetes, or babies born to mothers
who have overactive parathyroid glands.
Congenital hypoparathyroidism
DiGeorge's syndrome. This is a congenital condition - you are born with it. The parathyroid glands do not develop
properly while the baby is growing in the womb. People with this syndrome have hypoparathyroidism. Also, their
immune system does not work properly and they may have heart problems and problems with the development
of the roof of their mouth (a cleft palate).
Congenital hypoparathyroidism can also be one of a number of problems (a syndrome). One example is
hypoparathyroidism that occurs with deafness and problems with kidney development. Most syndromes have
unusual names.
Inherited hypoparathyroidism
Hypoparathyroidism may be caused by an inherited problem caused by chemicals called antibodies attacking the
parathyroid gland. This is called an autoimmune illness. Normally, our body makes antibodies to fight infections for example, when we catch a cold or have a sore throat. These antibodies help to kill the cells of the bacteria,
viruses or other germs causing the infection. In autoimmune diseases the body makes similar antibodies (autoantibodies) that attack its normal cells. In autoimmune hypoparathyroidism, these auto-antibodies attack the cells
of the parathyroid glands. Autoimmune hypoparathyroidism can exist alone, or as part of a syndrome including
diabetes and thyroid gland disease.
Inherited hypoparathyroidism can also be caused by inherited problems with the gene that is needed for the body
to make parathyroid hormone. This means that the gene does not function properly which leads to a lack of
parathyroid hormone.
Pseudohypoparathyroidism
This is a rare disorder that is inherited. Parathyroid hormone is present in the body but the body is unable to
respond to it normally. There is a low calcium level in the blood. Affected people are short and have shortened
bones in their feet and hands. They may also have diabetes and an underactive thyroid gland.
Pseudopseudohypoparathyroidism
This occurs when someone has the features of pseudohypoparathyroidism, as described above, but they have
normal calcium and phosphate levels in the blood.
Page 3 of 5
What are the symptoms of hypoparathyroidism?
People experience the different symptoms of hypoparathyroidism in different ways. The symptoms are largely
due to the effects of low levels of calcium in the blood.
Mild symptoms usually develop slowly and may be fleeting or they may require a small adjustment in medication
(see below). Severe symptoms may come on rapidly and need urgent treatment. This may be with calcium given
directly into the vein via a drip (intravenously).
Possible symptoms that may occur include:
Muscle pains.
Tummy (abdominal) pains.
Tingling, vibrating, burning or numbness of the fingers, toes or face.
Twitching of the muscles of the face.
Carpopedal spasm (contraction, or tightening, of the muscles of the hands and feet).
Seizures.
Fainting.
Confusion.
Memory problems.
Tiredness.
Eyesight problems.
Headaches.
Brittle nails.
Dry skin and hair.
Painful periods.
Are there any complications of hypoparathyroidism?
Any complications that may arise are largely due to the low levels of calcium in the body. Complications can
include:
Kidney stones.
Cataracts.
Disturbance of the normal electrical activity of the heart. This can lead to irregularities in the heart
rhythm which can in turn lead to collapse.
Stunted growth, teeth problems and problems with mental development can occur if low calcium
levels are not treated in childhood.
How is hypoparathyroidism diagnosed?
Physical examination
There are a number of things that your doctor may look for when they examine you:
They may tap in front of your ear with your mouth slightly open. If your calcium level is low because of
hypoparathyroidism, this can cause repeated contraction (tightening) of the muscles in your face. This
is called Chvostek's sign.
Your doctor may also inflate a blood pressure cuff around the lower part of your arm. If your calcium
level is low because of hypoparathyroidism, this can lead to carpopedal spasm, as described above.
They may examine your eyes to look for cataracts which can be a complication of hypoparathyroidism.
They may examine your muscle reflexes. This is a painless examination done by tapping the tendons
of the muscles - for example, at the knee or the elbow. It is done using a special instrument called a
tendon hammer. If your calcium level is low due to hypoparathyroidism, these reflexes can be much
more forceful than normal.
Blood tests
Blood tests can confirm hypoparathyroidism. In hypoparathyroidism, your blood calcium level is low, your blood
phosphate level is high, and your parathyroid hormone level is low.
Page 4 of 5
If your doctor suspects that your hypoparathyroidism is caused by an autoimmune process, they may suggest
some other blood tests. For example, they may want to look at your thyroid gland to check that this is not also
affected.
Other possible investigations
Your doctor may suggest some other tests to look for the cause of your hypoparathyroidism. For example:
Hand X-rays - to look for the shortened bones seen in pseudohypoparathyroidism.
An ultrasound scan of the heart (echocardiogram) - to look for heart abnormalities associated with
DiGeorge's syndrome.
Genetic studies - special blood tests can be performed if your doctor suspects that you have an
inherited cause for your hypoparathyroidism.
What are the aims of treatment?
The aims of treatment are to ensure that there is an adequate level of calcium in the bloodstream. This should
mean that you will not have symptoms associated with low calcium levels.
What are the treatment options?
Calcium and vitamin D supplements
Hypoparathyroidism is treated with calcium and vitamin D supplements taken by mouth. Vitamin D supplements
are needed because vitamin D also helps to regulate calcium levels. It stimulates the release of calcium from
bone and helps calcium to be absorbed from the gut and the kidneys. Regular blood tests are needed to ensure
that you are taking enough calcium and vitamin D. Closer monitoring is needed during pregnancy, if you are also
taking other medicines, or if you also have another illness. Treatment is usually lifelong. These are not dietary
supplements that you can buy over the counter, but stronger medication requiring careful monitoring by your
doctor.
Intravenous calcium
If you have severe symptoms, you may need calcium given directly into your vein via a drip (intravenously).
Diet
A diet rich in calcium and vitamin D is also recommended.
Other treatments
There are other possible treatments for hypoparathyroidism. For example, if you have surgery to remove your
thyroid gland, one of the parathyroid glands may be transplanted (or moved) and re-sited in the neck or the arm.
This means that it can continue to release parathyroid hormone. There have also been trials carried out where
people with hypoparathyroidism have been given parathyroid hormone that has been made synthetically.
However, synthetic parathyroid hormone is not currently licensed in the UK to treat people with
hypoparathyroidism.
What is the outlook (prognosis)?
If hypoparathyroidism is adequately treated with calcium and vitamin D, the prognosis is good. However, this
relies on you taking medication daily for life. You also need to have regular blood tests so that the dose of your
medication can be carefully adjusted as needed.
Can hypoparathyroidism be prevented?
During thyroid or neck surgery, the surgeon must identify the parathyroid glands and avoid damaging them if
possible. Anybody who is undergoing thyroid or neck surgery, radiotherapy to the neck or the chest, or
chemotherapy (a treatment for cancer) should be monitored for symptoms and signs of low calcium levels.
Page 5 of 5
Another point about hypoparathyroidism
It is a good idea to have a medical emergency identification bracelet or equivalent to identify yourself as having
hypoparathyroidism. This is so that if you collapse, are confused or are found unconscious, doctors will know that
you need prompt treatment with calcium.
Further help & information
Hypopara UK
6 The Meads, East Grinstead, West Sussex, RH19 4DF
Tel: (Helpline) 01342 324091 (day), 01623 750330 (evening/weekend)
Web: hypopara.org.uk/
Further reading & references
Understanding the Causes of Hypoparathyroidism; Hypoparathyroidism UK
Al-Azem H, Khan AA; Hypoparathyroidism. Best Pract Res Clin Endocrinol Metab. 2012 Aug;26(4):517-22. doi:
10.1016/j.beem.2012.01.004. Epub 2012 May 31.
De Sanctis V, Soliman A, Fiscina B; Hypoparathyroidism: from diagnosis to treatment. Curr Opin Endocrinol Diabetes
Obes. 2012 Dec;19(6):435-42. doi: 10.1097/MED.0b013e3283591502.
Michels TC, Kelly KM; Parathyroid disorders. Am Fam Physician. 2013 Aug 15;88(4):249-57.
Cusano NE, Rubin MR, Sliney J Jr, et al; Mini-review: new therapeutic options in hypoparathyroidism. Endocrine. 2012
Jun;41(3):410-4. doi: 10.1007/s12020-012-9618-y. Epub 2012 Feb 7.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no
warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of
medical conditions. For details see our conditions.
Original Author:
Dr Michelle Wright
Current Version:
Dr Colin Tidy
Peer Reviewer:
Dr John Cox
Document ID:
7186 (v5)
Last Checked:
15/07/2014
Next Review:
14/07/2017
View this article online at: patient.info/health/hypoparathyroidism-leaflet
Discuss Hypoparathyroidism and find more trusted resources at Patient.
© Patient Platform Limited - All rights reserved.