Hypoparathyroidism

(Underactive Parathyroid)

Definition

The parathyroid glands are four pea-sized glands. They are located next to the thyroid gland in the neck. The glands send out the parathyroid hormone (PTH). PTH helps to control the level of calcium in the blood.

Hypoparathyroidism is when the glands do not send out enough PTH. This causes low levels of calcium in the blood. Low blood calcium is known as hypocalcemia.

Thyroid and Parathyroid Glands: Posterior (Back) View

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Copyright © Nucleus Medical Media, Inc.

Causes

Hypoparathyroidism may be caused by:

  • Removal of the parathyroid glands
  • Damage to the parathyroid glands
  • Problems of the immune system known as autoimmune disorder
  • Parathyroid gland was missing since birth
  • Genetics conditions, such as 22q11.2 deletion syndrome
  • Low levels of magnesium often due to alcohol use disorder and/or malnutrition
  • Metal overload from iron, magnesium, or aluminium

The exact cause is not always found.

Risk Factors

Things that may increase the chance of hypoparathyroidism include:

  • Multiple autoimmune disorders
  • Thyroid or parathyroid surgery
  • Others in the family have hypoparathyroidism

Symptoms

Hypoparathyroidism does not always cause symptoms. If symptoms do develop, they may include:

  • Tingling around the mouth, fingers, and toes
  • Weakness
  • Muscle cramps or twitching
  • Abnormal heart rhythm
  • Excessive nervousness or anxiety
  • Difficulty with breathing due to spasm of breathing tubes
  • Mood swings
  • Loss of memory and confusion
  • Blurred vision due to cataracts
  • Thin, brittle nails
  • Dry and scaly skin
  • Seizures

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done.

Blood and urine tests will be done. They can show PTH and calcium levels.

Treatment

Treatment options include the following:

Calcium and Vitamin D Supplements

Calcium and vitamin D is often needed. They are often taken as pills. Injections of calcium may be needed if symptoms are severe.

Parathyroid Hormone Replacement

Recombinant human parathyroid hormone may be used. It will fill in the missing PTH. It may be given if other treatment causes high calcium in blood and urine.

Prevention

There are no current steps on how to prevent hypoparathyroidism.

The parathyroid glands can be damaged during thyroid surgery. The surgeon may remove the parathyroid glands and place them in a new spot in neck or arm. This may prevent damage.

RESOURCES:

Hypoparathyroidism Association, Inc.
https://www.hypopara.org
National Organization for Rare Disorders
http://www.rarediseases.org

CANADIAN RESOURCES:

Canadian Society of Endocrinology & Metabolism
http://www.endo-metab.ca

References:

Brandi ML, Bilezikian JP, Shoback D, et al. Management of Hypoparathyroidism: Summary Statement and Guidelines. J Clin Endocrinol Metab. 2016 Jun;101(6):2273-83
Hypoparathyroidism. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114796/Hypoparathyroidism . Updated March 13, 2017. Accessed December 31, 2019.
Hypoparathyroidism. National Organization for Rare Disorders website. Available at:
...(Click grey area to select URL)
Updated April 2, 2014. Accessed December 31, 2019.
Moffett JM, Suliburk J. Parathyroid autotransplantation. Endocr Pract. 2011;17 Suppl 1:83-89.
Last reviewed December 2019 by EBSCO Medical Review Board Monica Zangwill, MD, MPH
Last Updated: 12/31/2019

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