Hypoparathyroidism – Symptoms, Causes, Diagnosis and Treatment

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Hypoparathyroidism is a disease that occurs when the parathyroid glands that are located in the neck behind the thyroid gland and are responsible for maintaining the level of minerals in the body, do not function properly. It may also be caused in case when the parathyroid glands secrete significantly low levels of parathyroid hormone (PTH), which is also known as Parathormone. Chronic hypoparathyroidism leads to a decreased level of calcium and an increased level of phosphorus to circulate in through the blood all over the body. This may have serious impact on the health of a person since calcium and phosphorus combine to form calcium phosphate that is responsible for strengthening the bones and providing energy to the body. In serious cases, one may suffer from hypoparathyroidism hypocalcaemia.

Hypoparathyroidism can be of several types depending on their specific cause such as transient hypoparathyroidism, congenital hypoparathyroidism, inherited or acquired hypoparathyroidism, pseudo hypoparathyroidism, and pseudo pseudo hypoparathyroidism. However, the type of hypoparathyroidism where the cause is not discernable is known as idiopathic hypoparathyroidism.

Hypoparathyroidism Signs and Symptoms

Some of the signs and symptoms of hypoparathyroidism may be enumerated as the following:-

  • Pain in the abdomen or the stomach.
  • Muscle contraction or tightening medically termed as Carpopedal or Tetanic contractions.
  • Problems associated with the eyesight and cataract formation in the eyes.
  • Headaches and extreme cases may lead to loss of memory. One may also suffer from a considerably decreased level of consciousness.
  • One may also experience the twitching of the facial muscles.
  • A tingling sensation of the lips, fingers and toes.
  • The drying up of the hair and the skin forming scales.
  • Weakening of the enamel of the tooth in children. One may also notice a delayed or no re-growth of the tooth at all once it has fallen.
  • The brittle formation of the nails of both the hands and the feet.
  • Women may experience painful menstruation and may have to undergo convulsions, commonly known as seizures.

Causes of Hypoparathyroidism

Although it has not been possible for scientists to detect the causes of every kind of hyperparathyroidism and that is the reason why one of its types has been named as Idiopathic, yet the scientists and doctors have attributed the causes for all other types as the following:-

  • Acquired hypoparathyroidism is the most common type of hypoparathyroidism that is caused by the accidental damage or removal of the parathyroid glands during a neck surgery or a surgery of the thyroid glands also known as Thyroidectomy. Such kinds of injury to the parathyroid glands may cause traumatize the glands and disrupt the flow of blood to them. In serious cases such as potential malignancy or cancer, the parathyroid hormones have to be intentionally removed which has an obvious repercussion of hypoparathyroidism. One may even have to go through a surgical removal of the parathyroid glands in case of overactive parathyroid glands. Such surgeries may increase the risk of getting affected with hypoparathyroidism.

One may also acquire hyperparathyroidism as an ill-effect of undergoing radiotherapy to treat neck or chest cancer or even hyperthyroidism. This is due to the fact that radioactive rays or radioactive iodine treatment and drugs severely damages the parathyroid glands and make them dysfunctional.

An acquired autoimmune problem such as the autoimmune polyendocrine syndromes in which case autoantibodies invade and attack the parathyroid cells and cause their ultimate destruction may also lead to hypoparathyroidism of both acquired and inherited kinds.

  • Inherited hyperparathyroidism may be caused by a number of inherited problems related to the immune system. One who suffers from immune problems may have the autoantibodies attacking the cells of the parathyroid glands, thereby causing inherited or autoimmune hyperparathyroidism. It may also be associated with other metabolic and auto immune syndromes such as diabetes and diseases related to the thyroid glands. Hypoparathyroidism risk factors may be strongly associated with one’s family history.

It may also be caused due to problems related to the gene that is responsible for making parathyroid hormones in the body. Such cases may be associated with the dysfunctioning of the respective genes. One may also be born without the parathyroid glands, which is a quite serious case. Endocrine diseases such as type I Polyglandular Autoimmune Syndrome (PGA I) which is characterized by adrenal insufficiency is also responsible for inherited hyperparathyroidism.

  • The case of transient hypoparathyroidism is most common in premature babies who unfortunately lack parathyroid glands since birth or have dysfunctional glands which are not able to perform their usual task of producing parathyroid hormones. Hypoparathyroidism association with diabetes and thyroid problems may cause diabetic mothers or women suffering from overactive parathyroid glands give birth to babies suffering from transient hyperparathyroidism.
  • The absence of parathyroid glands or its dysfunction may cause congenital hypoparathyroidism which is associated with chromosome 22q 11 microdeletion syndrome, also known as DiGeorge Syndrome. It is also referred to as Velocardiofacial or Schprintzen Syndrome and may give rise to a cleft palate and heart problems. Congenital hypoparathyroidism may also be associated with deafness or other nephrological problems.
  • Pseudo hypoparathyroidism is a rare disorder in which case the body is unable to respond to the parathyroid hormone. In this case, the normal growth of the person affected is restricted leading to a short body. In fact, low calcium levels contribute to abnormally short hands and feet. It may also be associated with diabetes and poorly active thyroid glands.
  • Pseudo pseudo hypoparathyroidism is an advancement of pseudo hypoparathyroidism but may be characterized by only one distinction wherein the normal levels of calcium and phosphate are somewhat maintained.

Hypoparathyroidism Complications

The possible complications that may be associated with hypoparathyroidism may be as the following:-

  • Hyperthyroidism can harm the heart by creating irregularities in the normal rhythm of the heart and disturb its normal electrical activity.
  • A child affected with hypoparathyroidism since birth may suffer from poor and slow mental and physical growth. Low calcium levels can also cause certain dental problems such as malformation of the teeth.
  • Its treatment with high dose of vitamin D and calcium tablets and medications may cause a very high level of calcium in blood, a condition also known as Hypercalcemia.
  • Hypoparathyroidism may also lead to the formation of kidney stones and other kidney problems.
  • Recurrent cataract formation may be noticed in case of hypoparathyroidism.
  • Larynx spasms and seizures are also other complications that may arrive out of hypoparathyroidism.
  • Other diseases such as Parkinson’s and Addison’s disease and pernicious anemia may also be caused while one suffers from hypoparathyroidism.

Diagnosis of Hypoparathyroidism

The diagnosis of hypoparathyroidism rests on the medical history of a person primarily to detect if the person has inherited the disease. The type and nature of symptoms and the surgeries and operations of the neck and or the thyroid that one may have gone through may be required for the proper diagnosis of hypoparathyroidism.

One may diagnose hypoparathyroidism by undergoing a blood test that shall help to detect the amount of calcium, serum albumin and PTH levels in blood. cAMP, a kind of urine test also helps in the detection of PTH levels in the body.

The physical examination that is usually conducted by doctor involves several methods such as the one which causes the repeated contraction of the facial muscles, testing the blood pressure with a sphygmomanometer to check if its inflation causes carpopedal spasm, examination of the eyes to check the formation of cataract, the tapping of the tendon hammer at the elbow or the knee to check the muscle reflexes. Hypoparathyroidism in children can be detected by examining their teeth.

X-rays of the hands and the legs to detect the exact cause of the shortening of bones of the body may consider the case to be associated with pseudo hypoparathyroidism. The ECG of the heart can detect abnormal heart rhythms and other problems related to the heart.

Hypoparathyroidism Treatment

The treatment of hypoparathyroidism is primarily concerned with ways and means to remedy the proportion of calcium and phosphorus in the body which is in an indefinite proportion in the course of the disease. For this purpose one is prescribed calcium and vitamin supplements in the form of tablets. Ergocalciferol, calcitriol and dihydrotachysterol are some of its forms.  One suffering from severe hypoparathyroidism or hypocalcaemia may have to be treated with the intravenous form of calcium. One must keep a tab on the amount of calcium and vitamin D that one takes in while one undergoes a treatment for hypoparathyroidism since an overdose may have strong repercussions on the health. This can be done by testing the blood on a more or less regular basis. This is most necessary in the case of pregnant women and those suffering from other chronic diseases.

Severe hypoparathyroidism can lead to tetany which needs to be dealt with Intravenous infusion (IV) of calcium. Hypoparathyroidism diet must focus on items that are rich in calcium content such as dairy products, cereals, fruit juice, and green vegetables along with kale and broccoli. Since hypoparathyroidism is also associated with high phosphorus levels, a diet poor in phosphorus content must form a part and parcel of the diet for hypoparathyroidism. For this reason one may be asked to avoid eggs, meat and carbonated drinks since all of them have a high content of phosphorus.

One may also be prescribed a diuretic medication if the calcium levels do not recede with the normal medication. Such a medication would include thiazide diuretic like metolazone and hydrochlorothiazide.

The best treatment for hypoparathyroidism is to follow the rules laid down by the endocrinologist life long since hypoparathyroidism is a lifelong disease. One must also sincerely follow the dietary chart abiding by the restrictions imposed to ensure a balanced mineral level in the body. One’s sincerity helps in the prevention of the complications associated with hypoparathyroidism.

References :

Wikipedia

www.patient.co.uk/health

www.mayoclinic.com/health

www.ncbi.nlm.nih.gov/pubmedhealth

www.medicinenet.com

One Response

  1. Gayle Engeman April 25, 2011
  2. Pingback: Hyperphosphatemia September 26, 2011

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