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Hipoparatireoidismo

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 13 Aug 2025
Last updated: 15 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • história de cirurgia de tireoide, paratireoide ou laringe
  • alcoolismo crônico
  • desnutrição, má absorção, diarreia
  • contrações musculares, espasmos, cãibras
  • parestesias, dormência
  • memória fraca, raciocínio lento
  • sinal de Chvostek
  • convulsões
  • batimento cardíaco irregular, taquicardia
  • sinal de Trousseau
Full details

Other diagnostic factors

  • ansiedade
  • cabelo seco, unhas quebradiças
  • catarata
  • história de candidíase mucocutânea
  • história de transfusões crônicas em pacientes com talassemia
  • dispneia
  • laringoespasmo
Full details

Risk factors

  • cirurgia de tireoide
  • cirurgia de paratireoide
  • hipomagnesemia
  • hipercalcemia materna moderada e crônica (hipocalcemia neonatal)
  • doenças autossômicas dominantes (por exemplo, mutações em CASR, GATA3)
  • hemocromatose hereditária
  • sobrecarga férrica transfusional na talassemia
  • Doença de Wilson
  • câncer metastático
Full details

Diagnostic tests

1st tests to order

  • cálcio sérico
  • nível plasmático de paratormônio (PTH) intacto
  • albumina sérica
  • magnésio sérico
  • 25-hidroxivitamina D sérica
  • fósforo sérico
  • creatinina sérica
  • eletrocardiograma (ECG)
Full details

Tests to consider

  • cálcio e creatinina urinários de 24 horas
  • magnésio e creatinina de 24 horas
  • testes da função hepática
  • gasometria arterial
  • tiroxina livre sérica, tireotrofina
  • teste de estímulo com hormônio adrenocorticotrópico (ACTH) e níveis de cortisol pela manhã
  • hemograma completo
  • ferro, transferrina e ferritina séricos
  • cobre sérico
  • exame oftalmológico
  • audiologia
  • cintilografia renal
  • autoanticorpos para interferon tipo 1 ou 21-hidroxilase
  • sequenciamento do gene
Full details

Treatment algorithm

INITIAL

hipocalcemia sintomática grave (cálcio total sérico corrigido para albumina <1.88 mmol/L [<7.5 mg/dL])

ACUTE

hipocalcemia temporária pós-cirúrgica assintomática

ONGOING

hipoparatireoidismo crônico

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 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

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.

Disclosures

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

Mannstadt M, Cianferotti L, Gafni RI, et al. Hypoparathyroidism: genetics and diagnosis. J Bone Miner Res. 2022 Dec;37(12):2615-29.Full text  Abstract

Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018 Jul;28(7):830-41.Full text  Abstract

Gafni RI, Collins MT. Hypoparathyroidism. N Engl J Med. 2019 May 2;380(18):1738-47. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Hipoparatireoidismo images

  • Differentials

    • Hipomagnesemia
    • Hipoalbuminemia
    • Doença renal crônica
    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

  • Videos

    Sinal de Trousseau

    sinal de Chvostek

    More videos
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