Word on Health

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Word On Hypoparathyroidism

Our grateful thanks to Emma Thomas from the charity Hypopara UK for her contribution to our 'on air' report. Thank you to Hypopara UK for the use of the information below - there is much more detailed information on their website.

So what is hypoparathyroidism?  It is a rare endocrine condition in which insufficient or inactive levels of parathyroid hormone (PTH) are produced by the parathyroid glands in your neck. This leads to low calcium levels in your blood, a condition called hypocalcaemia.

What causes hypoparathyroidism?  It is caused by a group of conditions in which low calcium and high phosphate levels occur as a result of insufficient or inactive parathyroid hormone secretion.

These conditions fall into two main types of hypoparathyroidism:

Iatrogenic hypoparathyroidism - is acquired by the surgical removal of, or damage to, the parathyroid glands . Iatrogenic means 'caused by treatment'.

Hypoparathyroidism without a defined cause (such as surgery) is calledidiopathic hypoparathyroidism. This is the name of a group of rare conditions which may be either congenital (occurring in the womb) or acquired in childhood or later in life as an inherited and /or autoimmune condition.

Symptoms  - There are no symptoms of hypoparathyroidism (low parathyroid hormone levels). There are symptoms of hypocalcaemia (low calcium levels).

Individuals may feel different symptoms in different ways and will often have their own (quite narrow) individual range within the normal reference range where they feel symptom free.

LOW CALCIUM

Symptoms are those of tetany and develop along a spectrum ranging from mild to more severe.

Asymptomatic: - Many people have no symptoms at all once their calcium and vitamin D levels are properly adjusted. as levels do fluctuate , blood tests are still important so that occasional blips may be adjusted. People with Idiopathic forms of hypoparathyroidism, once on medication, seem to be able to tolerate lower levels of calcium than post surgical types who may experience more fluctuations.

Mild symptoms: - Many people experience only mild symptoms which may require no action or just an occasional minor adjustment. These usually take the form of paraesthesias - tingling in the hands, fingers, and around the mouth, and twitching muscles.

Severe symptoms: -  These are more unusual but may occur post operatively or when medication has been inadequate over a period of time or in brittle hypoparathyroidism where levels remain constantly unstable. Symptoms may develop over time if ignored or unrecognised, or they may come on rapidly suddenly requiring urgent action to avoid a crisis.

Warning signs may be a drop in temperature, sensitivity to sound, shakiness, irritability, anxiety, diarrhea and gradually worsening muscle spasms.

Early symptoms of tetany may include:

  • Tingling or numbness in the hands and/or feet
  • Tingling or numbness in the face especially around the mouth
  • Irritability
  • Brain fog
  • Tiredness
  • Headache
  • Diarrhea
  • Twitching or trembly muscles
  • Sudden temperature drop

If not treated , more severe symptoms may develop and can include:

  • Increasing brain fog, feeling 'out of it
  • Worsening tetany, feeling very shaky and trembly inside (not visible)
  • Hard to function or move around
  • Carpopedal spasm (painful muscle spasms or cramps of the hands and feet)
  • Painful muscle spasms all over the body
  • High anxiety
  • Confusion
  • Severe muscle cramps
  • Seizures (this is rare)

Other symptoms may develop over time

  • Cardiac effects
  • Memory loss
  • Depression
  • Dry skin and itching, dry hair
  • Cataracts and eye problems
  • Dental problems
  • Kidney stones
  • Kidney failure

HIGH CALCIUM: - Vitamin D and calcium treatment requires regular blood testing as calcium levels  can fluctuate in response to many factors and medication occasionally needs to  be adjusted. This can also involve a certain amount of guesswork as well. So people with Hypoparathyroidism can sometimes develop high calcium levels, the symptoms to look out for.

Early warning signs can include:

  • Extreme tiredness and lethargy
  • Feeling weak
  • Not wanting to eat much
  • Constipation
  • Loss of concentration and interest in doing things
  • Mild confusion

If the hypercalcaemia is not treated then the symptoms become much worse and can include

  • Feeling and being sick
  • Drowsiness
  • Passing large amounts of urine
  • Feeling very thirsty
  • Dehydration
  • Confusion
  • Agitation
  • Muscle spasms, tremors.
  • Bone pain and weakness
  • Irregular heart beat
  • Difficulty thinking and speaking clearly

If patients have any of these symptoms they are advised to contact their doctor immediately to arrange a blood test. Left untreated this can be a life threatening condition.

Diagnosis  - How is hypoparathyroidism diagnosed?

Blood tests: - Hypoparathyroidism is usually diagnosed via a simple calcium blood test. In Hypoparathyroidism, your blood calcium level is low, your blood phosphate level is high, and your parathyroid hormone level is low.

Further blood tests may then be carried out to confirm this diagnosis such as :

  • thyroid function
  • kidney function
  • liver
  • bone profile
  • vitamin D levels 

Bone & Kidney Scans: - 

Urine tests: - 

Physical examination: 

Genetic Testing

Doctors may suggest some other tests to look for the cause of the Hypoparathyroidism, for example:

Hand x-rays 

Echocardiogram (an ultrasound scan of the heart). 

For more detailed information on Hypoparathyroidism and for help and support visit the Hypopara UK website 

All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.