Summary
Definition
History and exam
Key diagnostic factors
- history of thyroid, parathyroid, or laryngeal surgery
- chronic alcoholism
- malnutrition, malabsorption, diarrhoea
- muscle twitches, spasms, cramps
- paraesthesias, numbness, tingling
- poor memory, slowed thinking
- Chvostek’s sign
- convulsions
- irregular heart beat, tachycardia
- Trousseau sign
Other diagnostic factors
- anxiety
- dry hair, brittle nails
- cataracts
- history of mucocutaneous candidiasis
- history of chronic transfusions in patients with thalassaemia
- dyspnoea
- laryngeal spasm
Risk factors
- thyroid surgery
- parathyroid surgery
- hypomagnesaemia
- moderate and chronic maternal hypercalcaemia (neonatal hypocalcaemia)
- autosomal dominant conditions (e.g., mutations in CASR, GATA3)
- hereditary haemochromatosis
- transfusional iron overload in thalassaemia
- Wilson's disease
- metastatic cancer
Diagnostic investigations
1st investigations to order
- serum calcium
- serum albumin
- ECG
- plasma intact PTH
- serum magnesium
- serum 25-hydroxyvitamin D
- serum phosphorus
- serum creatinine
Investigations to consider
- 24-hour urine calcium, creatinine
- 24-hour magnesium, creatinine
- liver function tests
- arterial blood gases (ABGs)
- serum free thyroxine, thyrotropin
- morning cortisol and adrenocorticotropin (ACTH) stimulation testing
- full blood count
- serum iron, transferrin, ferritin
- serum copper
- ophthalmological examination
- audiology
- renal imaging
- gene sequencing
Emerging tests
- autoantibodies to 21-hydroxylase or type 1 interferons
Treatment algorithm
severe symptomatic hypocalcaemia (albumin-corrected serum total calcium <1.88 mmol [<7.5 mg/dL])
asymptomatic temporary postoperative hypocalcaemia
chronic hypoparathyroidism
Contributors
Authors
Dolores Shoback, MD
Professor of Medicine
University of California San Francisco
Endocrine Research Unit
San Francisco VA Medical Center
San Francisco
CA
Disclosures
DS worked as a consultant for Takeda Pharmaceuticals, Ascendis, and Bridge Bio. She has received honorarium from Neopharma, and served as an expert witness for a patient-based malpractice case. For the past 5 years, DS was a speaker for the annual patients and caregivers conference on hypoparathyroidism for the US-based Hypoparathyroidism Association, and is an unpaid member of their medical advisory board. DS has given many CME lectures on hypoparathyroidism and calcium and bone and mineral disorders.
Quan-Yang Duh, MD
Professor of Surgery
Section of Endocrine Surgery
University of California San Francisco
San Francisco
CA
Disclosures
QYD declares that he has no competing interests.
Acknowledgements
Professors Dolores Shoback and Quan-Yang Duh would like to gratefully acknowledge Professor Ronald Merrell, a previous contributor to this topic. RM declares that he has no competing interests.
Peer reviewers
Wail Malaty, MD
Adjunct Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
NC
Disclosures
WM declares that he has no competing interests.
Differentials
- Hypovitaminosis D
- Hypomagnesaemia
- Hypoalbuminemia
More DifferentialsGuidelines
- Standards of care for hypoparathyroidism in adults: a Canadian and international consensus
- Postoperative hypoparathyroidism: diagnosis, prevention, and management in adults
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