There are four parathyroid glands, located near each of the two lobes of the thyroid gland. The parathyroids produce parathyroid hormones that regulate blood levels of calcium necessary for strong bones and teeth, nerve function, and blood clotting. Hypoparathyroidism is a rare disorder associated with insufficient production of parathyroid hormone, the inability to make a usable form of parathyroid hormone, or the inability of kidneys and bones to respond to parathyroid hormone production. A deficiency of parathyroid hormone lowers blood calcium levels and raises phosphate levels. Hypoparathyroidism either may be inherited or acquired; the acquired form usually results from parathyroid surgery or an underlying disorder, such as cancer or neck trauma.
Signs and Symptoms
Hypoparathyroidism is often accompanied by the following signs and symptoms:- Muscle spasm or cramping, typically in hands or feet
- Convulsions
- Cataracts
- Hair loss
- Dry skin or malformed nails
- Anxiety
- Abnormal sensations such as numbness, tingling, or burning, especially around the mouth and fingers
- Candidiasis (yeast infection), in cases resulting from autoimmune polyglandular syndrome, type I
- Poor tooth development
- Vomiting
- Headaches
- Mental deficiency
What Causes It?
Hypoparathyroidism results from a variety of causes, as listed below:- Underdeveloped parathyroid glands at birth
- Medical treatment (radiation to thyroid gland, drug treatment, thyroid or parathyroid surgery)
- An underlying medical condition such as cancer, neck trauma, Wilson's disease (high level of copper in tissues), an excess of iron in tissues, low levels of magnesium
Who's Most At Risk?
People with the following conditions or characteristics are at risk for developing hypoparathyroidism:- Genetic factors
- Medications that suppress the parathyroid gland, such as asparagine, doxorubicin, cytosine arabinoside, cimetidine, and preparations containing aluminum
- Surgery or removal of the parathyroid gland
- Extensive radiation to or removal of the thyroid gland
What to Expect at Your Provider's Office
Your healthcare provider will conduct a physical examination, checking for muscle spasms, twitching, and seizures. He or she will examine the skin for problems such as dry skin, thinning hair, and fungal infections. In the case of infants, the provider will ask about and check for vomiting, swollen abdomen, apnea (temporary cessation of breathing), and an occasional bluish discoloration. Blood tests can reveal levels of low calcium, high phosphate, decreased magnesium, decreased parathyroid hormone, and other abnormalities. X rays or computed tomography (CT) scans may be used to check for abnormalities in the bones and soft tissues.Treatment Options
Prevention
No preventive measures are available for congenital hypoparathyroidism. However, changes in surgical techniques and medical treatment for thyroid and parathyroid disorders are helping to preserve parathyroid glands and reduce the occurrence of acquired hypoparathyroidism.Treatment Plan
A lifelong regimen of dietary and/or supplemental calcium and vitamin D is usually required to restore calcium and mineral balance. In the acute phase of hypoparathyroidism, calcium will be administered intravenously; diuretics may be prescribed in that circumstance as well to prevent over excretion of calcium in the urine and to reduce the amount of calcium and vitamin D needed.Complementary and Alternative Therapies
As mentioned, calcium and vitamin D supplements are the main treatment for hypoparathyroidism. Dietary choices may help maintain the right balance of these and other nutrients as well.Nutrition
The following supplements have been used clinically for the purposes indicated and, therefore, may be valuable adjuncts in the treatment of hypoparathyroidism:
- Calcium if dietary intake is not adequate
- Magnesium aids in the absorption of calcium; plus, often low levels of magnesium are present in the case of hypoparathyroidism
- Boron enhances the absorption of calcium
- Vitamin K, produced by bacteria in the intestines or obtained through the diet (e.g. dark leafy greens) is important for the uptake of calcium by cells throughout the body
- Almonds
- Legumes
- Dark leafy greens
- Blackstrap molasses
- Oats
- Sardines
- Tahini
- Prunes
- Apricots
- Sea vegetables
- Limit carbonated beverages, as they are high in phosphates and may reduce calcium absorption; dairy may diminish calcium absorption for similar reasons.
- Avoid caffeine (such as in coffee, black tea, colas, and chocolate); it can lead to calcium loss through the urine.
Herbs rich in minerals, such as the following, have been used in traditional remedies to support normal bone growth:
- Horsetail (Equisetum avense)
- Oat straw (Avena sativa)
Homeopaths may use the following remedies to treat problems related to calcium levels:
- Calcarea carbonica (calcium carbonate)
- Calcarea phosphorica (calcium phosphate)
Prognosis/Possible Complications
The prognosis for hypoparathyroidism is fair to good, especially when a diagnosis is made early. Several complications may occur, including acute muscle spasms leading to breathing problems; cataracts; muscle, ligament, and nervous system disorders; and stunted growth, tooth malformations, and mental retardation in childhood.Following Up
Those who have hypoparathyroidism will require lifelong monitoring by a healthcare provider.References
Baclofen. NMIHI. Accessed at http://www.nmihi.com/b/baclofen.html on November 9, 2018.
Berkow R, Fletcher AJ, Beers MH, eds. The Merck Manual. Rahway, NJ: Merck & Co Inc; 1992:1005-1007.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill Book Co; 1998.
Gupta MM. Calcium imbalance in hypoparathyroidism. J Assoc Physicians India. 1991;39(8):616-618.
Hormone replacement therapy (HRT). NMIHI. Accessed at http://drugs.nmihi.com/hormone-replacement.htm on November 9, 2018.
Reber PM, Heath H III. Hypocalcemic emergencies. Med Clin North Am. 1995;79(1):93-106.
What is hypoparathyroidism? NIH. Accessed at https://www.nichd.nih.gov/ on November 9, 2018.