Hypoparathyroidism: parathyroid glands are not active enough

Hypoparathyroidism is a disorder caused by the hypofunction of the parathyroid glands, caracterised by a very low concentration of the parathyroid hormone(PTH), of calcium and an increase in the concentration of blood fosforus.

PTH is responsible for maintaining normal serum calcium levels. It facilitates calcium absorption in the digestive tract by activating vitamin D in the kidneys, which then migrates to the intestinal epithelium. PTH also promotes bone resorption by indirectly increasing the activity of osteoclasts in bone and enhancing calcium reabsorption by the distal tubules of nephrons.

Thus, hypoparathyroidism typically leads to hypocalcemia. This dysfunction also affects renal function and bone metabolism.

The common causes of hypoparathyroidism include:

• Autoimmune attack on the parathyroid glands
• Very low magnesium levels in the blood
• Radioactive iodine treatment for hyperthyroidism

Less common causes include:

• DiGeorge syndrome: a condition characterized by the absence of parathyroid glands at birth
• Familial hypoparathyroidism: often accompanied by other endocrine diseases such as congenital adrenal insufficiency

The onset of the disease is very gradual, and symptoms may be mild. Sometimes, symptoms are so subtle that patients are unaware of the condition until blood tests reveal low calcium levels.

Symptoms may include:

• Tingling in the lips, fingers, and toes (common)
• Muscle cramps (common)
• Muscle spasms, called tetany (which may affect the larynx and cause breathing difficulty)
• Abdominal pain
• Abnormal heart rhythms
• Brittle nails
• Cataracts
• Calcium deposits in tissues
• Reduced consciousness
• Dry, coarse hair
• Dry, scaly skin
• Pain in the face, legs, and feet
• Painful menstruation
• Deizures
• Delayed or absent tooth eruption

Key risk factors include:

• Recent neck surgery, especially involving the thyroid gland
• Family history of hypoparathyroidism
• Autoimmune or endocrine conditions, such as Addison's disease, which reduces adrenal hormone production (like cortisol)

The condition can be detected through blood tests measuring:

• PTH
• Calcium
• Magnesium
• Vitamin D

Additional evaluations may include a 24-hour urine test and other diagnostic imaging to gain a more comprehensive understanding of the dysfunction, such as:

• Electrocardiogram (ECG) to check for abnormal heart rhythms
• Computed tomography (CT) scan to detect calcium deposits in the brain

The goal of treatment is to reduce symptoms and restore the balance of calcium and other minerals in the body.

To archive this goal the treatment consists in calcium carbonate and vitamin D supplements: Blood levels are regularly monitored to ensure proper dosing.

It is recommended to follow a balanced diet rich in calcium and low in phosphorus.

In some cases, additional interventions may be recommended PTH injections and intravenous calcium for life-threatening calcium deficiencies.

There are no specific actions to prevent hypoparathyroidism. However, avoiding unnecessary neck or thyroid surgeries may reduce the risk of developing the condition.