Low Parathyroid-Hypoparathyroidism- Symptoms, Treatment : Dr. Zaidi

Low parathyroid hormone is a serious medical condition. It can be life-threatening if not treated promptly by an experienced endocrinologist or parathyroid surgeon.

Let me first explain what parathyroid glands are, and what is their normal function. Then, I will explain how a person develops low parathyroid, which we doctors call hypoparathyroidism.

What are Parathyroid Glands?

The Parathyroid Glands are located in the neck just behind the thyroid gland, hence the name parathyroid glands. In most people, there are a total of four parathyroid glands, but some may have three while others may have five.

parathyroid and thyroid glands

The function of the parathyroid glands is to regulate calcium and phosphorus metabolism in the body.

Causes of Hypoparathyroidism

The most common cause for hypoparathyroidism is surgical removal of the parathyroid glands at the time of thyroid surgery. Typically, a surgeon carries out a total removal of thyroid gland in a patient with thyroid cancer. Inadvertently, he may remove all the parathyroid glands which are embedded in the posterior aspect of the thyroid gland.. Sometimes, he may be able to identify and save parathyroid glands at the time of surgery. However, parathyroid glands may suffer from inadequate blood supply due to damage to the blood vessels at the time of surgery. Subsequently, patient develops hypoparathyroidism, weeks or even months later after the thyroid surgery.

Rarely, hypoparathyroidism can be congenital or acquired as an autoimmune disorder.

Diagnostic Tests

Blood test for Calcium. Typically calcium level is low.
Blood test for Phosphorus. Typically phosphorus level is high.
Blood level of parathyroid hormone (PTH) is low.
24-hours Urine test which shows excessive calcium loss.

Symptoms of Hypoparathyroidism

Symptoms are due to the low calcium level.

Usual symptoms are muscle spasms, twitching and tetany. Typically, there is involuntary contractions of muscles of hands and feet (Carpo-pedal spasms). In addition, there is tingling around mouth (circumoral paresthesias)

A severely low calcium level can cause cardiac arrest and death.

Treatment of Hypoparathyroidism

Calcium and vitamin D supplementation in high doses is the mainstay treatment.

Calcium tablets: such as Calcium Carbonate

Vitamin D in a synthetic form, called Calcitriol, which is a prescription drug.

Typically a diet rich in calcium and low in phosphorus is recommended. That means a person should consume more dairy, broccoli and green leafy vegetables. And avoid carbonated soft drink, processed meats, nuts and grains.

Sometimes, a patient may need to receive intravenous calcium if calcium level is too low.

Close monitoring of calcium and phosphorus is important. You should be under the care of an experienced endocrinologist in this regard.

Yorvipath (palopegteriparatide) is a FDA-approved drug for use in adults with hypoparathyroidism. It was not studied in adults with acute post-surgical hypoparathyroidism. In addition, this drug has many serious side-effects include serious fluctuations in calcium levels, dizziness due to low blood pressure upon standing as well as risk for bone cancer.

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