Hypoparathyroidism

Description

Hypoparathyroidism is an uncommon condition in which the body produces abnormally low levels of parathyroid hormone (PTH). the parathyroid hormone (PTH) is key for the regulation and maintenance of a balance of the two minerals in the body — calcium and phosphorus.

The low production of PTH in hypoparathyroidism leads to abnormally low levels of calcium in the blood and an increase of phosphorus in the blood.

Supplements to bring levels of calcium and phosphorus in the normal range, the treatment of the condition. Depending on the cause of hypoparathyroidism, it is likely that you will need to take supplements for life. Sometimes the parathyroid hormone replacement is necessary if the supplements are not sufficient to achieve levels in a normal range.

Symptoms

The signs and symptoms of hypoparathyroidism are usually related to low levels of calcium in the blood. Signs and symptoms may include:

  • Burning or tingling sensation in the fingertips, toes and lips
  • Muscle aches or cramps in the legs, feet, stomach or side
  • Contractions or spasms of the muscles, especially around the mouth, but also in the hands, arms, and throat
  • Fatigue or weakness

Other signs and symptoms associated with hypoparathyroidism may include:

  • Painful menstrual periods
  • Hair loss in patches
  • Dry, thick skin
  • Brittle nails
  • Depression or anxiety

When to see a doctor

If you have signs or symptoms associated with hypoparathyroidism, consult your health care provider for an evaluation. Contact your health-care provider immediately if you have a seizure or have difficulty breathing. These can be complications of hypoparathyroidism.

Causes

Hypothyroidism occurs when the parathyroid glands do not produce enough parathyroid hormone. There are four small parathyroid glands in the neck behind the thyroid gland.

Parathyroid hormone controls the levels of calcium and phosphorus, so that very little parathyroid hormone causes abnormal levels of:

  • Calcium. This mineral is stored in the bones and teeth, and it makes it hard. Calcium is also needed for muscle function, to help the nerves and the brain to function properly, and to control the heart rate and blood pressure.
  • The phosphorus. This mineral is found in all cells, but primarily in the bones. Phosphorus is necessary to help the body create energy from food. Phosphorus also helps the muscles, the nerves, the heart and the kidneys of the function.

Causes of hypoparathyroidism may include:

  • The neck surgery. This is the most common cause of hypoparathyroidism. It develops after damage or accidental removal of the parathyroid glands during surgery. The neck may perform a surgery to treat conditions of the thyroid gland, or for the treatment of the throat or neck cancer.
  • Autoimmune disease. In some cases, the immune system attacks parathyroid tissues as if they were foreign bodies. In the process, the parathyroid glands to stop producing its hormones.
  • Hereditary hypoparathyroidism. This form can be the result of either born without parathyroid glands or glands that do not work correctly. Some types of hereditary hypoparathyroidism is associated with deficiencies of other glands that produce hormones.
  • Low levels of magnesium in the blood. Low levels of magnesium can affect the function of the parathyroid glands. Normal levels of magnesium are required for the normal production of the parathyroid hormone.
  • Extensive treatment of cancer by radiotherapy of the face or neck. The radiation can result in the destruction of the parathyroid glands. In rare cases, treatment with radioactive iodine for hyperthyroidism can lead to hypoparathyroidism.

Risk factors

Factors that may increase the risk of hypoparathyroidism include:

  • Recent neck surgery, especially if the thyroid was involved
  • A family history of hypoparathyroidism
  • Having certain autoimmune or endocrine conditions, such as Addison's disease — which causes a decrease in the hormones produced by the adrenal gland

Complications

Hypoparathyroidism can result in both reversible and irreversible complications.

Reversible complications

Complications due to the low levels of calcium that may improve with treatment include:

  • Type of spasm spasms of the hands and fingers, which can be prolonged and painful.
  • Pain and muscle contractions or spasms of the muscles of the face, throat or arms. When these spasms occur in the throat, which can interfere with breathing, the creation of a possible emergency.
  • Feeling a tingling or burning sensation, or a feeling of pins-and-needles, on the lips, tongue, fingers, and toes.
  • Seizures.
  • Problems with kidney function, such as kidney stones and kidney failure.
  • Abnormal heart rhythms (cardiac arrhythmias), and fainting, and even heart failure.

Irreversible complications

The accurate diagnosis and treatment can prevent these complications or prevent it from getting worse. But once they occur, take calcium and vitamin D does not usually reverse the damage. Irreversible complications include:

  • Hardening and changes in the shape of the bones, and the poor growth
  • Delay in mental development of children
  • Calcium deposits in the brain, which can cause problems with balance, movement disorders and seizures
  • Cloudy vision due to cataracts
  • Teeth that do not form properly, which affect the tooth enamel and the roots, which can happen when the hypoparathyroidism occurs at an early age, when the teeth are developing

Prevention

There are No specific measures to prevent hypoparathyroidism. However, if you are scheduled to have thyroid or neck surgery, talk with your surgeon about the risk of damage to your parathyroid glands during the procedure. Your health care provider may choose to test the calcium, parathyroid hormone and vitamin D levels and have you begin taking supplements if necessary prior to surgery.

Parathyroid autotransplantation may be an option to reduce the chances of hypoparathyroidism after surgery. The surgeon works to preserve the parathyroid tissue in the neck during the procedure. Sometimes, however, the surgeon may need to move parathyroid tissue to another area of the body, such as the arm or the chest muscle. Transplanted parathyroid tissue does not always work.

If you have had surgery or radiation that involve the thyroid or neck, slope of the signs and symptoms that could indicate hypoparathyroidism, such as a tingling or burning sensation in the fingers, toes, or lips, or muscle spasms or cramps. If they occur, your doctor might recommend prompt treatment with calcium and vitamin D to minimize the effects of the disease.

Hypoparathyroidism

Diagnosis

To diagnose hypothyroidism, your health care provider will discuss your medical history and perform a physical exam, and may suggest a blood test, and urine.

Blood tests

These blood test results could suggest the hypoparathyroidism:

  • A low blood calcium level
  • A low level of parathyroid hormone
  • A high blood level of phosphorus

A part of the blood level of magnesium can also be done. A low blood level of magnesium can cause a low blood level of calcium.

Urine test

Parathyroid hormone acts on the kidneys to avoid an excess of calcium lost in the urine. A urine test can tell if your body is getting rid of the excess calcium.

Other tests

Your doctor may order additional tests, such as blood tests or a blood test to check your heart rhythm (electrocardiogram, ECG).

Treatment

The goal of treatment is to relieve symptoms and to bring levels of calcium and phosphorus in the body again in a standard range.

Generally, treatment includes:

  • Of calcium by mouth. Oral calcium supplements — such as tablets, chewable tablets, or liquid can increase the levels of calcium in the blood. However, in high doses, calcium supplements can cause digestive side effects, such as constipation in some people.
  • Vitamin D. High doses of vitamin D, usually in the form of calcitriol, you can help your body absorb calcium and to remove the phosphorus. Calcitriol is a prescription from your health care provider for the active vitamin D. This is different from the usual supplements that you can get without a prescription.
  • The magnesium. If your magnesium level is low and you are experiencing the symptoms of hypoparathyroidism, you may need to take a magnesium supplement.
  • The thiazide diuretics. If calcium levels are still low with the treatment, or if the amount of calcium in the urine is very high, thiazide diuretics may help to decrease the amount of calcium lost in the urine.
  • Replacement of the parathyroid hormone. The Food and Drug Administration (FDA) has approved the parathyroid hormone (Natpara) to low blood calcium due to hypoparathyroidism. This is a single daily injection. Because of the potential risk of bone cancer (osteosarcoma), a risk that is observed in animal studies, this drug is available only through a restricted program. The program limits the use to the people whose calcium levels cannot be controlled with calcium and vitamin D supplements and that you understand the risks.

Diet

Your health care provider may recommend that you see a registered dietitian, who is likely to advise a diet:

  • Rich in calcium. This includes dairy products, green leafy vegetables, broccoli, and foods with added calcium, such as some orange juices, and breakfast cereals.
  • Low phosphorus content. This means avoiding soda, which contain phosphorus in the form of phosphoric acid, and limiting processed foods, meats, cheeses, nuts, and whole grains.

Intravenous infusion

If you need immediate relief of symptoms, you may need to stay in the hospital, so that you can get calcium through a small tube into a vein in the hand or arm (intravenously). You'll also take oral vitamin D tablets. After leaving the hospital, so it will continue to take calcium and vitamin D tablets.

Monitoring

Your health care provider will regularly check your blood to check the levels of calcium and phosphorus. In the first place, these tests will probably be weekly to monthly. Finally, you will need blood tests only twice a year. Regular testing allows for the adjustment of their calcium supplements dose if blood calcium levels increase or decrease.

Because hypoparathyroidism is usually a long duration of the disorder, the trials and the treatment usually lasts a lifetime.

Preparing for your appointment

It is likely to start by seeing your primary care provider. It could then be referred to a specialist in the treatment of hormone disorders (endocrinologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting for a specific test. Have a family member or friend with you, if possible, to help you remember the information they give you.

Before your appointment, make a list of:

  • Its symptoms, including those that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including major stresses or recent life changes and your and your family's medical history
  • All the drugs, vitamins, herbs and other supplements that you take, including over-dose
  • Questions to ask your health care provider

Questions may include:

  • What is likely causing my symptoms?
  • What are other possible causes?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available, and which do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • How can I best manage this condition with my other health conditions?
  • You should see a specialist?
  • Do I have to change my diet?
  • Are there brochures or other printed material that I can take? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask questions such as:

  • Has recently had a surgery in the neck?
  • Have received radiation therapy to the head or neck, or therapy for the treatment of thyroid problems?
  • Have someone in your family has had similar symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Hypoparathyroidism