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Last reviewed: 4 Sep 2023
Last updated: 13 Jun 2023



History and exam

Key diagnostic factors

  • history of thyroid, parathyroid, or laryngeal surgery
  • chronic alcoholism
  • malnutrition, malabsorption, diarrhea
  • muscle twitches, spasms, cramps
  • paresthesias, numbness, tingling
  • poor memory, slowed thinking
  • Chvostek sign
  • convulsions
  • irregular heart beat, tachycardia
  • Trousseau sign
More key diagnostic factors

Other diagnostic factors

  • anxiety
  • dry hair, brittle nails
  • cataracts
  • history of mucocutaneous candidiasis
  • history of chronic transfusions in patients with thalassemia
  • dyspnea
  • laryngeal spasm
Other diagnostic factors

Risk factors

  • thyroid surgery
  • parathyroid surgery
  • hypomagnesemia
  • moderate and chronic maternal hypercalcemia (neonatal hypocalcemia)
  • autosomal dominant conditions (e.g., mutations in CASR, GATA3)
  • hereditary hemochromatosis
  • transfusional iron overload in thalassemia
  • Wilson disease
  • metastatic cancer
More risk factors

Diagnostic investigations

1st investigations to order

  • serum calcium
  • plasma intact PTH
  • serum albumin
  • serum magnesium
  • serum 25-hydroxyvitamin D
  • serum phosphorus
  • serum creatinine
  • ECG
More 1st investigations to order

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
  • complete blood count
  • serum iron, transferrin, ferritin
  • serum copper
  • ophthalmologic exam
  • audiology
  • renal imaging
  • autoantibodies to type 1 interferon or 21-hydroxylase
  • gene sequencing
More investigations to consider

Treatment algorithm


severe symptomatic hypocalcemia (albumin-corrected serum total calcium <7.5 mg/dL [<1.88 mmol/L])


asymptomatic temporary postoperative hypocalcemia


chronic hypoparathyroidism



Dolores Shoback, MD

Professor of Medicine

University of California San Francisco

Endocrine Research Unit

San Francisco VA Medical Center

San Francisco



DS declares that her institution receives research money from Ascendis Pharmaceuticals to conduct a clinical trial in hypoparathyroid patients on which she is the Principal Investigator. This company is testing a new treatment for hypoparathyroidism. DS has participated in an advisory board for Ascendis (Dec 2022) to review data on this new treatment.

Quan-Yang Duh, MD, FACS

Professor of Surgery

Section of Endocrine Surgery

University of California San Francisco

San Francisco



QYD declares that he has no competing interests.


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



WM declares that he has no competing interests.

  • Hypoparathyroidism images
  • Differentials

    • Hypomagnesemia
    • Hypoalbuminemia
    • Chronic kidney disease
    More Differentials
  • Guidelines

    • Evaluation and management of hypoparathyroidism: summary statement and guidelines
    • Standards of care for hypoparathyroidism in adults: a Canadian and international consensus
    More Guidelines
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