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Hypoparathyroidism

Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).

Causes

There are four tiny parathyroid glands in the neck, near or attached to the back side of the thyroid gland.

The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone.

Hypoparathyroidism occurs when the glands produce too little PTH. The blood calcium level falls, and the phosphorus level rises.

The most common cause of hypoparathyroidism is injury to the parathyroid glands during thyroid or neck surgery. It may also be caused by any of the following:

  • Radioactive iodine treatment for hyperthyroidism
  • Very low magnesium level in the blood
  • Autoimmune attack on the parathyroid glands

DiGeorge syndrome is a childhood disease in which hypoparathyroidism occurs because all the parathyroid glands are missing at birth.

Familial hypoparathyroidism occurs with other endocrine diseases, such as adrenal insufficiency, in a syndrome called type I polyglandular autoimmune syndrome (PGA I).

Symptoms

Symptoms may include any of the following:

Exams and Tests

Blood tests will be done to check calcium, phosphorus, magnesium, and PTH levels. An ECG may show abnormal heart rhythms.

A urine test may be done to determine how much calcium is being removed from the body.

Treatment

The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body.

Treatment involves calcium carbonate and vitamin D supplements. These usually must be taken for life. Blood levels are measured regularly to make sure that the dose is correct. A high-calcium, low-phosphorous diet is recommended.

Persons who have life-threatening attacks of low calcium levels or prolonged muscle contractions are given calcium through a vein (IV). Precautions are taken to prevent seizures or larynx spasms. The heart is monitored for abnormal rhythms until the person is stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth.

Outlook (Prognosis)

The outcome is likely to be good if the diagnosis is made early. But changes in the teeth, cataracts, and brain calcifications cannot be reversed in children who have undiagnosed hypoparathyroidism during development.

Possible Complications

Hypoparathyroidism in children may lead to poor growth, abnormal teeth, and slow mental development.

Too much treatment with vitamin D and calcium can cause high blood calcium (hypercalcemia) or high urine calcium (hypercalciuria). Excess treatment may sometimes interfere with kidney function, or even cause kidney failure.

Hypoparathyroidism increases the risk of:

When to Contact a Medical Professional

Call your health care provider if you develop any symptoms of hypoparathyroidism.

Seizures or breathing problems are an emergency. Call 911 or your local emergency number immediately.

References

Al-Azem H, Khan AA. Hypoparathyroidism. Best Pract Res Clin Endocrinol Metab. 2012;26:517-522.

Bringhurst FR, DeMay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 28.

Doyle DA. Hypoparathyroidism. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 565.

Update Date: 8/5/2014

Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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