Mind and Body: Head Games and Hypoparathyroidism
By Ken Anderson
But first I need to grasp myself (o-o-oh, that doesn’t sound right) the general physiology of human anatomy. The body naturally seeks to maintain its internal environment in a relatively constant balance (the condition of homeostasis), for without this stability, cells will not function effectively. This process is an ongoing dance between the eleven major systems, two of which are the Endocrine (parathyroid gland) and Nervous (brain) Systems. As hypoparathyroid adventurers, we can all demonstrate the relationship between low parathyroid activity, the Nervous System, and muscles, with the contractions of tetany. However, often we can only describe the intuitively felt connection between low parathyroid activity and psychological disorders such as depression, anxiety, and cognitive disorders. And, as many of you know, this seemingly obvious (and you would expect heavily researched) relationship of physical and mental or emotional concerns is somehow not as apparent when explaining symptoms to doctors, family, or friends.
The first step toward enlightenment would logically be my endocrinologist. Having been together as patient and doctor for about 12 years, I think he comprehends the level-tracking aspect of hypoparathyroidism and the interweaving of various factors in a complicated blending that can obscure cause from effect or even any relationship at all. I am not sure, though, that he will confidently and firmly link a presenting emotional or mental issue with known physical complications such as kidney disease or carpal tunnel syndrome.
A clearer distinction between mental and physical often seems to be readily concluded by my doctors, as if what occurs in the mind and emotions is somehow separate from the physical state of hypoparathyroidism. However, the mental health professionals I’ve consulted have consistently suggested a stronger connection between a hypoparathyroid cause and mental and emotional effects, both in cognitive ability and mood shifts. Bringing the physical side of my health care together with the mental side has been unsuccessful. The former disputes much of the contentions of the latter, and the latter cannot go any further in advancing my well-being without greater support from the former. Consequently, I become confused, discouraged, and lost in the middle.
And we are here as on a darkling plain
OK. Well, then, I need to do my own research to garner evidence in support of what I feel to be true, that my mental and emotional state is directly impacted by lower calcium levels. The internet, library, and appropriate message boards / support groups are the easiest resources to check, and given more time and energy, I could contact a local medical school or the health science departments of nearby colleges for assistance.
As extremely interesting as the parathyroid glands are, the brain is even more incredible. As stated in Chapter 2 of “Mental Health: A Report of the Surgeon General”
“As befits the organ of the mind, the human brain is the most complex structure ever investigated by our science. The brain contains approximately 100 billion nerve cells, or neurons, and many more supporting cells, or ganglia.”
And I thought starting our old lawn mower was becoming too complicated.
How well the brain functions depends upon the ability of these neurons to communicate effectively with each other. In simple terminology, this communication process involves a connection via a synapse, the functional junction linking one neuron to another, usually through electrical signals, although it could also be chemical.
To again quote from “Mental Health: A Report of the Surgeon General:”
“In aggregate, there may be between 100 trillion and a quadrillion synapses in the brain. These synapses are far from random. Within each region of the brain, there is an exquisite architecture consisting of layers and other anatomic substructures in which synaptic connections are formed. Ultimately, the pattern of synaptic connections gives rise to what are called circuits in the brain. At the integrative level, large- and small-scale circuits are the substrates of behavior and of mental life. One of the most awe-inspiring mysteries of brain science is how neuronal activity within circuits gives rise to behavior and, even, consciousness.”
So, within my brain, these billions of neurons are forming circuits, with a specific purpose and logic behind each guiding the synaptic connections. Could my hypoparathyroidism be, in effect, a mental circuit breaker?
A starting point is found in a statement on page xxi in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association, Washington, DC, 1994:
“…the term mental disorder unfortunately implies a distinction between “mental” disorders and “physical” disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much “physical” in “mental” disorders and much “mental” in “physical” disorders. The problem raised by the term “mental” disorders has been much clearer than its solution…”
This foothold provides encouragement for seeking further details and in-depth analysis concurring with the broad premise that hypoparathyroidism can directly affect mental and emotional states.
I check the Yahoo HPTH message board and find numerous postings mentioning foggy brain syndrome, mental lethargy, and depression, indicating from this small sampling at least a very possible connection between body and mind. Well, at least I am not alone.
Extracts from an article in the Chronicle of Neurology and Psychiatry (2003, volume 8, pages 13-14) titled
“A Review of Neurological and Psychiatric Problems in Hyperparathyroidism and Hypoparathyroidism” (authored by Colin R. Paterson, DM, FRCP, Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland) provide additional insight and more terms to look up:
“Apart from tetany, the main neurological disorders associated with hypoparathyroidism are epilepsy, Parkinsonism, and chorea. … Intracranial calcification, particularly calcification of the basal ganglia, has long been recognized as a feature of idiopathic (auto-immune) hypoparathyroidism and pseudohypoparathyroidism. A minority of patients affected also develop Parkinsonism with tremor, athetosis, rigidity, ataxia, and oculogyric crises. … As with other patients with hypocalcemia, hypoparathyroidism may cause mental changes such as anxiety and depression. A small number of patients have been described with dementia … Psychotic symptoms including delusions and auditory hallucinations have been described in hypoparathyroidism. … Both disorders (hypo- and hyperparathyroidism) may cause non-specific psychiatric problems including, rarely psychosis. It is important that these are recognized since the neurological and psychiatric problems are readily and often completely relieved by normalization of the plasma calcium.”
Whoa. I need a medical dictionary for every other word. Referring to the “Principles of Anatomy and Physiology” eighth edition, written by Gerard J. Tortora and Sandra Reynolds Grabowski (Addison Wesley Longman, Inc., New York???, 1996), the following terms are defined:
And by searching the Merriam-Webster Medical Dictionary, Medline Plus Health Information site (www2.merriam-webster.com), I can define the remaining terms:
From all this, I am learning how things are supposed to work and some of the problems that may accompany hypoparathyroidism. The words were a bit scary even before I understood their definitions, but to not comprehend much of anything and leave the learning about my illness to others (including professionals) is way more frightening. Further internet research and reading locate additional statements supporting the mind and body connection:
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), American Psychiatric Association, Washington, DC, 1994, gives a broad statement that anxiety or mood symptoms may be caused by a variety of general medical conditions, including endocrine conditions such as hypoparathyroidism.
An article titled “Hypoparathyroidism” by John Halpern, DO, FACEP, Clinical Assistant Professor, Department of Family Medicine, Nova Southeastern University College of Osteopathic Medicine, Medical Director, Department of Emergency Medicine, Coral Springs Medical Center, and N Ewen Wang, MD, Consulting Staff, Department of Surgery, Division of Emergency Medicine, Stanford University Hospital (on eMedicine.com), identifies the neurologic effects of hypoparathyroidism: an altered mental status, psychosis, or altered level of consciousness in adults; hyper-irritability, muscle rigidity with normal mental status, or seizures in infants.
In an article titled “Mental Disorders Secondary to General Medical Conditions” by Linda Chuang, MD, and Nancy Forman, MD, (also found on eMedicine.com), the authors reassert that “imbalances of calcium and magnesium can cause psychiatric symptoms” and state that “Patients most commonly experience delirium but may also experience psychosis, depression, or anxiety.”
In the February 2002 issue of the European Journal of Endocrinology (146, Number 2: 215-222, an article titled “Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D” by Wiebke Arlt (Department of Medicine, Endocrine and Diabetes Unit, University of Wuerzburg, Germany) et al, discussed findings that hypoparathyroid patients had higher levels of “anxiety, phobic anxiety, and their physical equivalents.” Of perhaps greater consequence, the study concluded that the current method of treating hypoparathyroid patients fails to restore well-being and mood.
From the Complementary Medicine: The Best of Conventional and Alternative Treatments web site online library (www.ivillagehealth.com), the article “Hypoparathyroidism” echoed the assertion that “hypoparathyroidism is often accompanied by anxiety.” Additionally, the article mentioned that “mental deficiency often appears in children with hypoparathyroidism” and, a very crucial point, that “hypoparathyroidism has a fair to good prognosis, especially when a diagnosis is made early.”
In “Hypoparathyroidism and Pseudohypoparathyroidism” by David E. C. Cole and Geoffrey N. Hendy (Chapter 9 of Diseases of Bone and Calcium Metabolism; www.endotext.org), the “wide variation in the severity of the symptoms” of hypoparathyroidism is acknowledged in both the physical and emotional presentations, and that “other less specific manifestations include fatigue, irritability, and personality disturbance.”
From Psychiacomp (www.psychiacomp.com), an article titled “Medical Disorders Due to a General Medical Condition” also supports the contention that hypoparathyroidism is one of the common medical disorders associated with psychosis or mood disorders. The article recognizes a common-sense notion that “Chronic medical disorders themselves predispose an individual to developing a true major depression.”
From the book "Organic Psychiatry" by W. A. Lishman, Third Edition, 1998, Blackwell Science, Inc., the author (a primary catalyst of neuropsychiatry in the United Kingdom) wrote: “A wide variety and a high incidence of psychiatric disturbances have emerged in hypoparathyroidism. Denko and Kaelbling (1962) estimate that at least half the cases attributable to surgery have psychiatric symptoms, and that the frequency is probably higher still in idiopathic hypoparathyroidism.... Such patients [both types] may show sustained difficulty with concentration, emotional lability [mood swings and easily upset]... Children show temper tantrums and night terrors, and adults become depressed, nervous and irritable with frequent crying spells and marked social withdrawal... More rarely, psychotic illness of manic-depressive or schizophrenic type may be seen, particularly in cases due to surgery...”
Idiopathic hypoparathyroidism is also addressed in another article, “Idiopathic Hypoparathyroidism with Intracranial Calcifications and Dominant Skin Manifestations” (Med Sci Monit, 2000; 6(1): 145-150) by Zbigniew Stelmasiak (Department and Clinic of Neurology, Medical University, Lublin, Poland), et al. This article reiterates the importance of early and correct diagnosis and treatment (“Early diagnosis and treatment of patients with hypoparathyroidism may prevent the development of many serious complications or at least result in marked improvement of neurological manifestations.”) Other significant points made by the authors are quoted below:
The following abstracts are from the PubMed National Library of Medicine (www.ncbi.nlm.nih.gov):
The final reference regarding the relationship between hypoparathyroidism and mental or emotional issues are excerpts from an article from Dr. Richard C. W. Hall Publications (www.drrichardhall.com/anxiety.htm), titled “Anxiety and Endocrine Disease” (by Richard C. W. Hall, M.D., Courtesy Clinical Professor of Psychiatry, University of Florida, Gainesville, and Ryan C. W. Hall, Research Assistant, Behavioral Genetics Laboratory, Department of Psychiatry, Johns Hopkins Hospital Undergraduate Departments Biology/Psychiatry Johns Hopkins University):
Enough, enough, I say. If I did not have a hypoparathyroidism-induced mental disorder before, I surely must have now after reading these symptoms. But maybe these research findings and references are sufficient for providing enough fortitude for me to articulately push for the respectful recognition of those symptoms which do annoy me, and to seek for the appropriate, thorough treatment for what I intuitively know to be true.
With Summer coming to a close and with kids returning to school and leaving for college, my mind returns to long-ago days of my youth, of a time when mind and body where healthier, and the end of August would mean a return to school. I find that any reminiscence tends to remind me of music of that time, like the very appropriate 1978 song (for the warm weather and hotter coeds) again by Foreigner titled “Hot Blooded,” which I have revised below to fit what I am like today:
Well, I’m Hypopara, check it and see.
You don’t have to check the lab, to know I am a bit low.
Now it’s up to you, we can work together, not apart.
That’s why I’m Hypopara, check it and see.
If I don’t feel right, like my calcium is light,
Yeah, I’m hypopara, check it and see.
Now it’s up to you, we can work together, not apart.
Well, I’m hypopara, check it and see.
Hypopara, all the time.