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Hypoparathyroidism: Causes, Symptoms, Diagnosis, Treatment, and Prevention

The condition hyperparathyroidism occurs when the body does not produce enough parathyroid hormone (PTH). PTH regulates calcium and phosphorus levels in the blood and bones. There are a number of problems that can result from hypoparathyroidism, including muscle spasms, tingling sensations, seizures, dental abnormalities, and bone disorders caused by low calcium levels and high phosphorus levels in the blood.

Causes of Hypoparathyroidism

There are two types of hypoparathyroidism: acquired and inherited. Acquired hypoparathyroidism occurs when the parathyroid glands are damaged or removed as a result of surgery, injury, infection, or autoimmune diseases. A genetic mutation or chromosomal abnormality may cause inherited hypoparathyroidism to be passed on from parents to children.

Some of the possible causes of acquired hypoparathyroidism include:

• Thyroid surgery, which can damage or remove the parathyroid glands that are located behind the thyroid gland in the neck

• Parathyroid surgery, which can damage or remove the parathyroid glands that are responsible for producing PTH

• Neck surgery, which can damage or remove the blood supply or nerves of the parathyroid glands

• Radiation therapy, which can damage or destroy the parathyroid glands or the surrounding tissues

• Autoimmune disease, such as Hashimoto’s thyroiditis or polyglandular autoimmune syndrome, which can cause the immune system to attack the parathyroid glands or other endocrine organs

• Magnesium deficiency, which can impair the function of the parathyroid glands or the response to PTH

Some of the possible causes of inherited hypoparathyroidism include:

• DiGeorge syndrome, which is a genetic disorder that affects the development of the thymus, parathyroid glands, and other organs

• Familial isolated hypoparathyroidism, which is a genetic disorder that affects the production or action of PTH

• Pseudohypoparathyroidism, which is a genetic disorder that affects the response of the body to PTH

• Hypoparathyroidism-retardation-dysmorphism syndrome, which is a genetic disorder that affects the development of the brain, face, and parathyroid glands

Symptoms of Hypoparathyroidism

The symptoms of hypoparathyroidism depend on the severity and duration of the condition, as well as the age and health status of the patient. Some of the common symptoms include:

• Muscle cramps, spasms, or twitching, which can affect the hands, feet, face, or throat

• Tingling or numbness, which can affect the lips, fingers, toes, or other parts of the body

• Seizures, which can result from abnormal electrical activity in the brain due to low calcium levels

• Confusion, anxiety, depression, or mood changes, which can result from the effects of low calcium levels on the nervous system

• Dry skin, brittle nails, or hair loss, which can result from the effects of low calcium levels on the skin and hair

• Cataracts, which can result from the deposition of calcium in the lenses of the eyes

• Dental problems, such as tooth decay, enamel hypoplasia, or delayed eruption of teeth, which can result from the effects of low calcium levels on the teeth and gums

• Bone problems, such as osteoporosis, osteomalacia, or fractures, which can result from the effects of low calcium levels on the bones and joints

Diagnosis of Hypoparathyroidism

The diagnosis of hypoparathyroidism is based on the medical history, physical examination, and laboratory tests. It is possible to identify the possible causes and symptoms of hypoparathyroidism as well as any other medical conditions that may affect calcium and phosphorus levels based on the medical history and physical examination. In the blood or urine, laboratory tests can be used to assess calcium, phosphorus, PTH, and other hormones or minerals, such as:

• Calcium, which is a mineral that is essential for the function of the muscles, nerves, and bones

• Phosphorus, which is a mineral that is important for the formation and maintenance of the bones and teeth

• Parathyroid hormone (PTH), which is a hormone that regulates the levels of calcium and phosphorus in the blood and bones

• Vitamin D, which is a hormone that helps the body to absorb calcium from the food and supplements

• Magnesium, which is a mineral that is involved in the function of the parathyroid glands and the response to PTH

• Alkaline phosphatase, which is an enzyme that is involved in the metabolism of the bones and other tissues

A person's level of these substances can indicate whether hypoparathyroidism is acquired or inherited, and how severe it is. A low calcium level and high PTH level suggest hypoparathyroidism, while a normal or high PTH level along with a low calcium level and a high phosphorus level indicates pseudohypoparathyroidism.

Other tests that may be done to confirm or rule out the diagnosis of hypoparathyroidism include:

• Electrocardiogram (ECG), which is a test that records the electrical activity of the heart and can detect any abnormal rhythms or patterns due to low calcium levels

• Electroencephalogram (EEG), which is a test that records the electrical activity of the brain and can detect any seizures or other neurological problems due to low calcium levels

• X-rays, which are tests that use radiation to create images of the bones and can detect any signs of osteoporosis, osteomalacia, or fractures

• Genetic tests, which are tests that analyze the DNA and can detect any mutations or abnormalities that may cause inherited hypoparathyroidism

Treatment of Hypoparathyroidism

It is important to consider the cause, type, and severity of hypoparathyroidism, as well as the patient's age and health status before treating it. During the treatment, calcium and phosphorus levels are restored to normal levels and functions in the blood and bones, and any complications that may arise from hypoparathyroidism are prevented or treated. Among the main types of treatment are:

• In order to increase levels of calcium and vitamin D in the body, calcium and vitamin D supplements are used either orally or intravenously. Patients with hypoparathyroidism can benefit from calcium and vitamin D supplements to relieve symptoms and improve quality of life, as well as to prevent or treat osteoporosis and other bone problems. Calcium and vitamin D supplements, however, can also cause hypercalcemia, kidney stones, constipation, or nausea, among other side effects. Therefore, calcium and vitamin D supplements should be used with caution and under the supervision of a doctor, who can monitor the calcium and phosphorus levels and adjust the dosage and frequency of the supplements accordingly.

• As a substitute for the deficient or absent hormone in the body, parathyroid hormone therapy uses synthetic or natural PTH. Using parathyroid hormone therapy can help to regulate calcium and phosphorus levels in the blood and bones, as well as stimulate bone growth. There are several ways to administer thyroid hormone therapy, including injections, pumps, and implants. In addition to reducing calcium and vitamin D supplements, parathyroid hormone therapy can improve bone density and strength in hypoparathyroidism patients. There are, however, some risks and side effects associated with parathyroid hormone therapy, including hypercalcemia, hypophosphatemia, headaches, or reactions to injection sites. Parathyroid hormone therapy should be used with caution and under the supervision of a physician who can monitor the PTH and calcium levels and adjust dosage and duration accordingly.

• Parathyroid surgery, in which operative techniques are used to restore or correct the function or appearance of the glands. The underlying causes of hypoparathyroidism, such as tumors, cysts, or injuries, or healthy parathyroid tissue transplanted from a donor or another part of the body, can be treated with surgery. Surgical procedures do, however, come with some risks and complications, including bleeding, infection, scarring, or damage to surrounding organs or tissues. It is therefore important that surgery is performed by a qualified and experienced surgeon, who can assess the benefits and risks of the procedure for each patient.

Prevention of Hypoparathyroidism

The prevention of hypoparathyroidism is not always possible, especially if the condition is caused by genetic or congenital factors. However, some of the possible ways to prevent or reduce the risk of hypoparathyroidism include:

• Avoiding or limiting the exposure to factors that may damage or impair the function of the parathyroid glands, such as surgery, injury, infection, radiation, or certain drugs

• Maintaining a healthy diet and lifestyle, which can help to provide adequate amounts of calcium, vitamin D, and magnesium, and to prevent or manage any metabolic disorders that may affect the calcium and phosphorus levels

• Seeking medical attention and treatment for any medical conditions that may cause or contribute to hypoparathyroidism, such as tumors, cysts, infections, or autoimmune diseases

• Consulting a doctor before starting or stopping any medications that may interfere with the secretion or action of PTH, such as diuretics, anticonvulsants, or bisphosphonates