Hypoparathyroidism

Hypoparathyroidism has a wide variety of presentations: from the asymptomatic patient with dramatically low serum calcium to the acutely symptomatic patient with neuromuscular irritability, tetany, painful muscle cramps, stridor, and even seizures with low serum calcium in the emergency department or recovery room.

Majority of cases are post-surgery for benign and malignant thyroid disorders, hyperparathyroidism, and laryngeal or other head and neck cancers.

Nonsurgical etiologies include: rare genetic conditions and syndromes; autoimmune destruction of the glands; destruction or invasion due to tumor, radiation, or infiltration by iron or copper; hypomagnesemia and magnesium depletion; and idiopathic.

Laboratory testing should confirm low ionized or albumin-corrected total calcium and low or inappropriately normal intact plasma parathyroid hormone, while also verifying normal serum magnesium and 25-hydroxyvitamin D levels.

If symptoms are present, replacement of calcium and/or magnesium should be promptly instituted with careful monitoring along with activated vitamin D metabolites for chronic treatment.

Hypoparathyroidism is caused by relative or absolute deficiency of plasma parathyroid hormone (PTH) synthesis and secretion.[1]Khan AA, Bilezikian JP, Brandi ML, et al. Evaluation and management of hypoparathyroidism summary statement and guidelines from the Second International Workshop. J Bone Miner Res. 2022 Dec;37(12):2568-85. https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.4691 http://www.ncbi.nlm.nih.gov/pubmed/36054621?tool=bestpractice.com ​ This leads to low albumin-corrected serum total calcium and elevated serum phosphate. Signs and symptoms can involve the neuromuscular, psychiatric, cardiac, ocular, dermatologic, gastrointestinal, and renal/urologic systems. Patients can also be asymptomatic.​​​

Definitions of permanent postsurgical hypoparathyroidism vary. Persistently low intact PTH levels in the presence of hypocalcemia requiring treatment for at least 6 months (some guidelines state at least 12 months) post-procedure generally indicates that the condition is permanent.