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Hypoparathyroidism

This is a patient information leaflet from Patient UK co-authored by HPTH UK

Hypoparathyroidism occurs when either insufficient levels of parathyroid hormone are released by the parathyroid glands in the neck, or the parathyroid hormone that is released does not work properly. It leads to low levels of calcium in the blood which causes a number of different symptoms, commonly muscle cramps, pain and twitching. It can be successfully treated with calcium and vitamin D supplements but regular blood test monitoring is needed.

What is hypoparathyroidism?

The body has four parathyroid glands. They 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 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 levels of 'active' parathyroid hormone causes calcium levels in the blood to fall and phosphate levels to rise.

Why does the body need calcium and phosphorus?

Calcium and phosphorus combine to make calcium phosphate in the body. This is the chief 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 the correct functioning of muscles and nerves. Phosphorus works in conjunction with calcium for these functions. Phosphorus is also needed for the production of energy within the body.

Who gets hypoparathyroidism?

Hypoparathyroidism is rare. It occurs equally in males and females. The age that someone may develop hypoparathyroidism depends on its cause.

What causes hypoparathyroidism?

Hypoparathyroidism can be:

  • Transient (short-lived).
  • Congenital (something that someone, for some reason, is born with).
  • Inherited (passed on through your genes from your relatives).
  • Acquired (something that develops in childhood or adult life for another reason).
  • Pseudohypoparathyroidism.
  • Pseudopseudohypoparathyroidism.

Transient hypoparathyroidism

  • This most commonly occurs in babies who are born prematurely. It can also occur in otherwise healthy babies born at the normal time. It is due to failure of parathyroid hormone to be released from the parathyroid glands normally after birth.
  • Transient hypoparathyroidism can also affect babies born to mothers who have diabetes or to mothers who have overactive parathyroid glands.

Congenital hypoparathyroidism

  • DiGeorge syndrome. This is a congenital condition where the parathyroid glands do not develop properly while the baby is growing in the uterus (womb). People with this syndrome have hypoparathyroidism. Also their immune system does not work properly and they may have heart problems and a cleft palate (problems with the development of the roof of their mouth).
  • Congenital hypoparathyroidism can also be part of another syndrome (a collection of problems). An example is hypoparathyroidism that occurs with deafness and also problems with kidney development.

Inherited hypoparathyroidism

  • Hypoparathyroidism may be caused by an inherited autoimmune problem. 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 "germs" causing the infection. In autoimmune diseases the body makes similar antibodies (autoantibodies) that attack its normal cells. In autoimmune hypoparathyroidism, these autoantibodies attack the cells of the parathyroid glands. Autoimmune hypoparathyroidism can exist alone, or as part of a syndrome of problems 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.

Acquired hypoparathyroidism

  • The most 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. The parathyroid glands may also be intentionally removed because of potential malignancy (cancer), or as a treatment for hyperparathyroidism (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 drugs 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 in turn causes a reduction in parathyroid hormone release and hypoparathyroidism.
  • Acquired hypoparathyroidism can also occur due to an acquired autoimmune condition. For some reason, autoantibodies start attacking the cells of the parathyroid glands and destroying them, as described above.

Pseudohypoparathyroidism

This is a rare disorder that is inherited. Parathyroid hormone is present in the body but the body is unable to respond normally to it. There are low calcium levels 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 is when someone has the features of pseudohypoparathyroidism, as described above, but they have normal calcium and phosphate levels in the blood.

What are the symptoms of hypoparathyroidism?

Individuals can experience different symptoms of hypoparathyroidism in different ways. The symptoms are largley 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 needing urgent treatment with calcium given intravenously (directly into the veins via a drip).

Possible symptoms that may occur include:

  • Muscle pains.
  • Abdominal (stomach) 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 menstruation (periods).

Are there any complications of hypoparathyroidism?

Any complications that may arise because of hypoparathyroidism are largely due to the low levels of calcium that it causes 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 if they suspect that you have hypoparathyroidism:

  • They may tap in front of your ear with your mouth slightly open. If your calcium levels are 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 levels are 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 levels are low due to hypoparathyroidism, these reflexes can be much more forceful than normal.

Blood tests

Your doctor will suggest some blood tests to confirm hypoparathyroidism. In hypoparathyroidism, your blood calcium level is low, your blood phosphate level is high, and your parathyroid hormone level is low. 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.
  • Echocardiogram (an ultrasound scan of the heart) - to look for heart abnormalities associated with DiGeorge 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 for hypoparathyroidism?

The aims of treatment are to ensure that there are adequate levels of calcium in the bloodstream. This should mean that you will not suffer from any of the symptoms associated with low calcium levels.

What are the treatment options for hypoparathyroidism?

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 intestine and the kidneys. Regular blood tests are needed to ensure that you are taking adequate amounts of calcium and vitamin D. Closer monitoring is needed during pregnancy, if you are also taking other drugs, or if you are also suffering from another illness. Treatment is usually lifelong. These are not dietary supplements that you can buy over-the-counter, but more potent medication requiring careful monitoring by your doctor.

Intravenous calcium

If you experience severe symptoms of low calcium levels, you may need treatment with intravenous calcium (the calcium is given directly into a vein via a drip).

 Diet

A diet rich in calcium and vitamin D is also recommended.

Other treatments

There are other possible treatments for hypoparathyroidism. If someone is having surgery to remove their 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 to treat people with hypoparathyroidism in the UK.

What is the prognosis (outlook) of hypoparathyroidism?

If hypoparathyroidism is adequately treated with calcium and vitamin D, the prognosis the prognosis is good. However, a good prognosis relies on the person who is affected taking their medication daily for life and also having regular blood tests so that the dose of their medication can be carefully adjusted as needed.

Can hypoparathyroidism be prevented?

During thyroid or neck surgery, care must be taken by the surgeon to identify and locate the parathyroid glands and to avoid damage to them if possible. Anybody who is undergoing thyroid or neck surgery, radiotherapy to the neck or the chest, or chemotherapy (drug treatment for cancer) should be monitored for symptoms and signs of low calcium levels.

Another point about hypoparathyroidism

You should wear a MedicAlert® bracelet, or carry some kind of ID with you, to identify yourself as suffering from hypoparathyroidism. This is so that if you collapse, are confused or are found unconscious, doctors will know that you need treatment with calcium. Please refer to the information below for details.

 

Further help and information

MedicAlert
1 Bridge Wharf, 156 Caledonian Road, London, N1 9UU

Freephone: 0800 581420 Web: www.medicalert.org.uk

A registered charity providing a life-saving identification system to protect and save lives.
Please contact HPTH UK for a 5% discount.

Hypoparathyroidism UK (HPTH UK)

 6 The Meads, East Grinstead, West Sussex, RH19 4DF
Web: www.hpth.org.uk
A voluntary organisation committed to improving the lives of people with hypoparathyroidism and other parathyroid disorders.

References

  • Thornton PS, Kelly A, Willcutts M; Hypoparathyroidism; eMedicine (July 2006); (Paediatric slanted article)
  • Understanding the causes of Hypoparathyroidism, Hypoparathyroidism UK. Information obtained from website in October 2007.
  • J. A. Kanis. Disorders of calcium metabolism, Hypoparathyroidism. Chapter 7.5.2. Concise Oxford Textbook of Medicine First edition - April 2000
  • Winer KK, Ko CW, Reynolds JC, et al; Long-term treatment of hypoparathyroidism: a randomized controlled study comparing parathyroid hormone-(1-34) versus calcitriol and calcium. J Clin Endocrinol Metab. 2003 Sep;88(9):4214-20. [abstract]

Comprehensive patient resources are available at www.patient.co.uk

 Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

© EMIS 2009 Reviewed: 22 Oct 2007 DocID: 7186 Version: 3

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest.

Related pages in Patient UK
Your Experience in partnership with Hypoparathyroidism UK

Please go to PAtinet UK to add your experience about this condition / medicine
View Patient Experience for 'Hypoparathyroidism' (5 there)

Support Groups related to this topic
Hypoparathyroidism UK

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Hypoparathyroidism


 


   
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