Diabetic ketoacidosis (DKA) is a life-threatening condition caused by a build-up of waste products called ketones in the blood. It occurs in people with diabetes when they have no – or very low levels of – insulin. DKA is most commonly seen in people with type 1 diabetes.…
- 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.
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 thyroid gland in the neck.
When there is not enough PTH, the calcium levels in the blood decrease and phosphorus levels increase.
Most commonly, hypoparathyroidism is caused by damage to the parathyroid glands during neck surgery.
Other causes include:
Risk factors for hypoparathyroidism include:
- Neck surgery;
- Having a family history of it, and;
- Autoimmune diseases such as Addison's disease.
Usually occurs as a result of accidental damage to the parathyroid glands during neck surgery, causing them to not produce enough PTH.
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.
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.
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;
- Seizures, and;
- Weakened tooth enamel in children.
Other symptoms that can sometimes occur include:
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.
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.
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:
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.
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.