Hypoparathyroidism has always been referred to as a “Rare Disorder” that in recent times is being found in larger numbers. The disorder results in low calcium levels due to low levels of parathyroid hormone. The incidence of cases in the U.S. that are not related to neck surgery total around 58,973. The projected growth of this disorder lies in the number of patients experiencing the condition after neck surgery, most often thyroidectomy or removal of the parathyroids. These cases have grown to over 75 percent of all people diagnosed.
The condition can be debilitating and require large amounts of calcium and vitamin D to prevent muscle spasms known as tetany or life-threatening cardiac events. It is often thought that calcium only affects the bones in your body, but it does much more. This article will explain the important role of calcium and the need for parathyroid hormone to help absorption in all the needed areas of the body. Causes, diagnosis and treatments are also outlined.
Hypoparathyroidism is a lack of parathyroid hormone from the parathyroid glands. The parathyroid glands are tiny glands located around the back of the thyroid gland. They actually have nothing to do with the actual thyroid, they are just located there. Parathyroid hormone helps to regulate calcium and phosphorus in your bloodstream. It helps to convert vitamin D to the active form, calcitriol that helps get calcium where it needs to go in the body. This in turn helps keep the levels of phosphorus from going too high.
Parathyroid hormone also prevents the kidneys from losing too much calcium in the urine and encourages bone turnover of calcium. This means when your blood levels of calcium gets lower than it should be, PTH encourages the bones to release a little calcium to correct any imbalances. People with hypoparathyroidism often have very dense bones, because their body does not do this.
Calcium does much more than build strong bones and teeth. Let’s take a look at the different things calcium does.
The Full Role of Calcium in Our Body
Calcium is a very important mineral and electrolyte that helps many processes in the body. These include:
Builds bones and teeth
Keeps the heartbeat normal
Helps with nerve transmission
Tells the muscles when to tighten and when to relax
Regulates some hormones and other chemicals in the body
Plays a role in brain function, memory, thought processes and mood
There are a few different types of hypoparathyroidism:
Acquired Hypoparathyroidism. Caused by parathyroid removal during thyroid surgery, parathyroidectomy, or damage to the glands.
Congenital Hypoparathyroidism. Non-working or absent parathyroid glands from birth.
Idiopathic Hypoparathyroidism. Hypoparathyroidism with no apparent cause. The parathyroids just cease to work. Onset can be at any time in life, either in childhood, young adulthood, or later years. No explanation can be found.
Autoimmune Hypoparathyroidism. The body’s own immune response attacks the parathyroid glands and damages them. One autoimmune disease that can lead to this is known as, “Polyglandular Autoimmune Syndrome (PGA). This can be accompanied by other disorders like; Type 1 Diabetes, Addison’s disease, Autoimmune Thyroid Disease, and Candida of the skin.
The symptoms of hypoparathyroidism are the same as symptoms of low calcium since that is what the lack of parathyroid hormone causes. These include:
Buzzing feeling all over the body
Anxiety or nervous feelings
Twitching of muscles
Muscle Spasms (Tetany) in the hands, feet, arms, legs, and face.
Numbness in the face and mouth
Hands and arms or legs and feet falling asleep
Trouble thinking clearly (Brain fog)
Mood Swings and irritability
Irregular Heartbeat (often slow heart rate or bradycardia)
Symptoms like tetany, irregular heartbeat or severe mood swings may signal a medical emergency. If you experience severe symptoms of low calcium, get emergency medical help.
If you have symptoms of low calcium, your doctor will check you for hypoparathyroidism. You will need to give a medical history such as; how long you have had your symptoms, history of neck surgeries, and family history. Let your doctor know any medications you are taking.
Your doctor will do a physical exam and check you for twitching by tapping the side of your face by your ear. If your mouth twitches (Chvostek’s sign), this could be low calcium. They will also inflate a blood pressure cuff on your arm and watch to see if your hand curls inward (Trousseau’s sign).
Your doctor may choose to order blood tests to confirm that you have low calcium and low parathyroid hormone. Other electrolyte levels may be checked.
Lab tests include:
Parathyroid (PTH) level
Vitamin D level
Potassium level. Not related, but magnesium can be low in hypoparathyroidism and this can cause low potassium levels.
24 hour urine calcium
Ionized calcium (To see the amount of calcium available for your body to use. This is often low in hypoparathyroidism, even if the serum calcium is normal)
Albumin level (Albumin binds calcium)
Kidney Function tests
You may need to see a dentist to have your teeth checked and a bone density study may be ordered. If you have severe problems with thinking or memory, the doctor may order a CT scan of your head to look for calcifications on your brain. You may also need your kidneys checked for calcifications or kidney stones.
You may need to see other doctors such as; an endocrinologist and/or nephrologist.
Treatment is aimed at bringing calcium levels close to “low normal” range. When you are treated with calcium, it is important not to take too much because this can affect your kidneys. It is also important to get enough to relieve your symptoms. Treatment includes:
Calcium Supplementation. You will need to use calcium supplements because your body will not absorb calcium from food as well. There are two types of calcium supplements that are used most often; calcium carbonate (only absorbed well if taken with food), calcium citrate (highly absorbable and can be taken with or without food).
Vitamin D. You will need to take vitamin D and possibly in very high doses. Some people who have very low PTH levels will need to take the activated form of vitamin D, calcitriol. This is available by prescription and needed if your body doesn’t have enough PTH to convert vitamin D from foods or sunlight.
Diuretics. If you have high levels of calcium in your urine, you may need to take a “calcium sparing” diuretic that prevents too much calcium from slipping out in the urine.
Parathyroid Hormone. Recently, a form of parathyroid hormone was approved by the FDA for daily injections. This eliminates the need for active vitamin D and calcium doses can be lowered next to none. This is known as rhPTH 1-84. In the past, a form of PTH known as 1-34 was used “off-label” for hypoparathyroidism, but required more than one injection every day and was not as effective as the once daily 1-84 which is the entire molecule that mimics what is produced by the parathyroid glands. Injectable parathyroid hormone is also designed to stop the kidneys from releasing too much calcium and encourages bone turnover as mentioned above.
Dietary Control. Hypoparathyroidism requires dietary management. You will need to avoid foods containing high amounts of phosphorus including; eggs, certain meats, large amounts of milk, caramel colored soft drinks, and processed bakery items. Phosphorus can lower calcium levels. You will also need to include more calcium rich foods like; dairy, green leafy vegetables, calcium enriched orange juice, kale, and broccoli.
Intravenous Calcium. If you have severe symptoms of low calcium, you may need intravenous calcium to bring your levels back up quickly. This is usually done if you are experiencing tetany muscle spasms, seizures, or irregular heartbeat.
Follow-up Care. You will need to keep in touch with your doctor and have your calcium and vitamin D levels checked on a regular basis. Since there is no home testing for calcium, some patients and doctors prefer “standing orders” so you can have your calcium checked when you feel symptoms. Hypoparathyroidism is most often a lifelong and chronic condition that needs calcium replacement daily for the rest of your life. Your needs for calcium may go up and down, but you will always need treatment.
Avoid getting dehydrated and hot weather. Keep yourself cool on hot days to avoid sweating and losing electrolytes, like calcium and magnesium. Drink plenty of fluids and rest.
Reduce Caffeine Intake and Quit Smoking. Coffee and cigarettes can leach magnesium and calcium from the system and reduce your ability to absorb these minerals.
Take a Multivitamin. Make sure you take the prescribed minerals your doctor tells you to use, but also get a good multivitamin that contains other essential nutrients.
Eat Calcium Rich Foods. Include plenty of the following foods in your diet; Legumes, oats, salmon, sardines, almonds, apricots, green leafy vegetables, and broccoli.
Drink Orange Juice. If you do not use calcium citrate, use a beverage that is acidic to help calcium absorption.
If hypoparathyroidism is treated early before calcium gets too low to cause severe symptoms, the outcome is very positive with proper treatment. The disease is very seldom fatal and severe symptoms can be treated in the hospital with intravenous calcium. As long as you are taking your calcium in prescribed doses every day and not missing doses, the disease is manageable. It can be disabling however if left untreated. This is due to complications which can include:
High blood calcium levels from too much calcium and D (Symptoms are; constipation, nausea, headache, bone pain, and weakness)
High urine calcium
Heart rhythm disturbances
Parkinson’s like symptoms
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