Fast facts

  • Hypoparathyroidism is when there is not enough parathyroid hormone in the body. This leads to low calcium levels and high phosphorus levels.
  • Hypoparathyroidism is often the result of injury to the parathyroid glands, usually as a result of neck surgery.
  • Symptoms can include muscle cramps and spasms, difficulty breathing, tingling in the fingers, toes and lips, pain in the legs, feet and face.
  • Treatment involves giving calcium and/or vitamin D as needed.
  • Left untreated, hypoparathyroidism can result in impaired kidney function, cataracts and Parkinson's disease, among other complications. In children, it can cause physical and mental developmental problems.

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Hormone

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Kidney

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Parathyroid glands

Small endocrine glands located in the neck behind the thyroid. They produce a hormone (parathyroid or PTH) that regulates the amounts of calcium and phosphate in the bones and blood.

Vitamin D

A vitamin that is important for the health of bones and teeth as it promotes absorption of calcium from the diet.

Phosphorus

An important mineral that is necessary for growth, formation of bones and teeth and energy metabolism.

What is hypoparathyroidism?

Parathyroid hormone (PTH) is a hormone that is responsible for regulating the levels of calcium, vitamin D and phosphorus in your blood and bones. PTH is produced in the parathyroid glands, four small glands found next to the tyroid gland in the neck.

When there is not enough PTH, the calcium levels in the blood decrease and phosphorus levels increase.

 

Macro anatomy of the thyroid. 

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Hormone

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Parathyroid glands

Small endocrine glands located in the neck behind the thyroid. They produce a hormone (parathyroid or PTH) that regulates the amounts of calcium and phosphate in the bones and blood.

Vitamin D

A vitamin that is important for the health of bones and teeth as it promotes absorption of calcium from the diet.

Phosphorus

An important mineral that is necessary for growth, formation of bones and teeth and energy metabolism.

Causes

Most commonly, hypoparathyroidism is caused by damage to the parathyroid glands during neck surgery.

Other causes include:

  • Radioactive iodine used as a treatment for hyperthyroidism;
  • Low magnesium levels in the blood, and;
  • Genetic causes inherited from parents or present at birth, such as DiGeorge syndrome (in which children are born without parathyroid glands) or type I polyglandular autoimmune syndrome.

Genetic

Related to genes, the body's units of inheritance or origin.

Parathyroid glands

Small endocrine glands located in the neck behind the thyroid. They produce a hormone (parathyroid or PTH) that regulates the amounts of calcium and phosphate in the bones and blood.

Magnesium

An important mineral that is essential for the development of bones and teeth, energy production and muscle contraction.

Risk factors

Risk factors for hypoparathyroidism include:

Addison's disease

A chronic condition in which the adrenal glands are damaged, leading to a reduction of the hormones cortisol and/or aldosterone. These hormones are important for daily bodily functions and their deficiency can lead to a wide variety of symptoms.

Autoimmune diseases

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Types

Primary hypoparathyroidism

Usually occurs as a result of accidental damage to the parathyroid glands during neck surgery, causing them to not produce enough PTH.

Secondary hypoparathyroidism

Occurs in response to high levels of calcium, which can be due to a number of causes. When calcium levels are high, the body does not produce as much PTH.

Pseudohypoparathyroidism

This is not really hypoparathyroidism at all. It occurs when cells in the kidneys and bones do not respond to PTH, so even though there is plenty of PTH, the body is still losing calcium.

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Kidneys

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Parathyroid glands

Small endocrine glands located in the neck behind the thyroid. They produce a hormone (parathyroid or PTH) that regulates the amounts of calcium and phosphate in the bones and blood.

Signs and symptoms

Signs and symptoms of hypoparathyroidism include:

  • Muscle cramps and spasms (known as tetany);
  • Muscle spasms in the larynx, causing difficulty breathing;
  • Tingling in the fingers, toes and lips;
  • Pain in the legs, feet and face;
  • Dry hair and scaly skin;
  • Cataracts;
  • Seizures, and;
  • Weakened tooth enamel in children.

Other symptoms that can sometimes occur include:

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Depression

A mental health disorder that results in physical and psychological symptoms such as low mood, a feeling of hopelessness, poor concentration and motivation, disruptive sleep patterns and appetite changes. To be diagnosed with depression, these symptoms must be present most days for at least two weeks.

Fatigue

A state of exhaustion and weakness.

Larynx

Also known as the voice box. Made of cartilage, it sits above the base of the throat and houses the vocal cords.

Menstruation

The periodic shedding of the lining of a woman's uterus. Typically occurring about every four weeks between puberty and menopause (except during pregnancy). The menstrual period varies between individuals, but typically lasts 3-5 days.

Seizures

A sudden, involuntary contraction of muscle groups caused by abnormal electrical activity in the brain.

Tooth enamel

The outer layer of the tooth. Typically 1-2mm thick, this is the whitest part of the tooth, forming a protective shell over the underlying dentine.

Methods for diagnosis

Early diagnosis is important in hypoparathyroidism, since the condition can cause permanent complications if it is not treated in time.

To diagnose hypoparathyroidism, the blood and urine are tested for calcium. The blood is also tested for PTH, phosphorus and vitamin D (vitamin D is measured to exclude vitamin D deficiency as the alternative cause of low calcium levels).

These tests can help diagnose the type of hypoparathyroidism you have:

  • In primary hypoparathyroidism, there are low PTH and calcium levels;
  • In pseudohypoparathyroidism, there is a higher level of PTH, and;
  • In secondary hypoparathyroidism, there are low PTH and high calcium levels.

A blood test. 

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Vitamin D

A vitamin that is important for the health of bones and teeth as it promotes absorption of calcium from the diet.

Phosphorus

An important mineral that is necessary for growth, formation of bones and teeth and energy metabolism.

Types of treatment

Giving calcium and vitamin D is currently the main treatment for primary hypoparathyroidism. Eating more foods rich in calcium, and fewer foods high in phosphorus (such as soft drinks, eggs and meats), may also be recommended.

Secondary hypoparathyroidism is treated by addressing the underlying cause.

Parathyroid hormone replacement is currently being studied as a potential treatment choice for hypoparathyroidism. 

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Hormone

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Vitamin D

A vitamin that is important for the health of bones and teeth as it promotes absorption of calcium from the diet.

Phosphorus

An important mineral that is necessary for growth, formation of bones and teeth and energy metabolism.

Potential complications

If hypoparathyroidism is not diagnosed in time, it may lead to complications. Some of these are temporary and will pass when the condition is treated. Other complications result from accumulated damage, and can be permanent.

Complications of hypoparathyroidism in children include:

  • Abnormal teeth;
  • Poor growth, and;
  • Poor mental development.

Other complications of hypoparathyroidism include:

Addison's disease

A chronic condition in which the adrenal glands are damaged, leading to a reduction of the hormones cortisol and/or aldosterone. These hormones are important for daily bodily functions and their deficiency can lead to a wide variety of symptoms.

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Kidney

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Pernicious anaemia

A condition in which the body cannot produce enough red blood cells due to a lack of vitamin B12.

Seizures

A sudden, involuntary contraction of muscle groups caused by abnormal electrical activity in the brain.

Vitamin D

A vitamin that is important for the health of bones and teeth as it promotes absorption of calcium from the diet.

Prognosis

Hypoparathyroidism can be a temporary condition that stops when its cause is treated, or a permanent condition. In both cases, you will have your blood calcium and vitamin D levels checked regularly, and given calcium and/or vitamin D as necessary. This will continue for as long as your condition persists.

So long as your condition is well-managed, you can lead a normal life.

If you have primary hypoparathyroidism, it is a good idea to wear a bracelet or chain that indicates that you have the condition; if you suffer a severe muscle spasm (tetany) due to lack of calcium, it can help paramedics to provide fast treatment.

Calcium

A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.

Vitamin D

A vitamin that is important for the health of bones and teeth as it promotes absorption of calcium from the diet.

Prevention

You cannot prevent hypoparathyroidism, but if you are having an operation on your neck, you can discuss the measures your surgeon will take to avoid damaging your parathyroid glands.

If you have had surgery on your neck, it is important to keep an eye out for any symptoms of hypoparathyroidism. Contact your doctor if you are concerned, as early treatment will improve your outcome.

Parathyroid glands

Small endocrine glands located in the neck behind the thyroid. They produce a hormone (parathyroid or PTH) that regulates the amounts of calcium and phosphate in the bones and blood.