Hypoparathyroidism is a condition in which your body secretes abnormally low levels of parathyroid hormone. This hormone plays a key role in regulating and maintaining a balance of your body's levels of two minerals — calcium and phosphorus. The low production of parathyroid hormone in hypoparathyroidism leads to abnormally reduced calcium levels (hypocalcemia) in your blood and bones. Hypoparathyroidism also leads to an increased amount of phosphorus (hyperphosphatemia). Treatment for hypoparathyroidism consists of taking supplements to normalize your levels of calcium and phosphorus. Because hypoparathyroidism is a chronic condition, treatment is generally lifelong.

Signs and symptoms of hypoparathyroidism can include:
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Tingling or burning (paresthesias) in your fingertips, toes and lips Muscle aches or cramps affecting your legs, feet, abdomen or face Twitching or spasms of your muscles, particularly around your mouth, but also in your hands, arms and throat Fatigue or weakness Painful menstruation Patchy hair loss, and thinning of your eyebrows Dry, course skin Malformation or splitting of your nails Anxiety or nervousness Headaches Depression, mood swings

Parathyroid glands

The hormone parathyroid is manufactured by the small oval-shaped parathyroid glands in your neck, adjacent to your thyroid gland. Each of your four parathyroid glands is about the size of a pea. Despite the similarity in names, the parathyroid glands are distinct from the thyroid gland, and have different functions in your body. Hypoparathyroidism occurs when your parathyroid glands don't secrete enough parathyroid hormone. Doctors frequently categorize hypoparathyroidism into "hereditary" and "acquired" forms of the condition, which relate to their cause:
 Hereditary hypoparathyroidism. In this form, either the parathyroid glands aren't present at birth or they don't work properly. Symptoms tend to become apparent in the first 10 years of life, and most often by about 2 years of age. This inherited genetic disorder is passed to a child through a recessive gene. When both parents are carriers of this genetic defect, a child's chances of inheriting the disease are 25 percent.

Acquired hypoparathyroidism. This form tends to develop after accidental damage to or removal of the parathyroid glands during surgery. This surgery may be a treatment for diseases of the nearby thyroid gland, or for throat or neck cancer. Acquired hypoparathyroidism occurs less commonly than it did in the past because surgeons are aware of and more careful to avoid injuring the parathyroid glands in the course of surgery. In a small number of cases of the acquired disease, the cause is an autoimmune disorder. In this situation, your immune system creates antibodies against the parathyroid tissues, trying to reject them as if they were foreign

bodies. In the process, the parathyroid glands stop manufacturing their hormones. Other causes Hypoparathyroidism can also be caused by:
 Extensive cancer radiation treatment of your face or neck, which can result in destruction of your parathyroid glands, or occasionally because of radioactive iodine treatment for hyperthyroidism. Low levels of magnesium in your blood, which can affect the function of your parathyroid glands. Normal magnesium levels are required for optimum secretion of parathyroid hormone. A condition called metabolic alkalosis, in which there are chemical imbalances in your bloodstream.

Risk factors
If you've had recent neck surgery, particularly if the thyroid was involved, you may have an increased risk of developing hypoparathyroidism. A family history of hypoparathyroidism also increases your risk. So does the presence of certain autoimmune or endocrine conditions, such as Addison's disease — a condition characterized by a deficit in hormone production by the adrenal glands. Hypoparathyroidism occurs in approximately equal numbers of males and females. Although it may occur at any age, it develops most commonly in children younger than 16 and in adults older than 40.

When to seek medical advice
If you have any of the signs and symptoms associated with hypoparathyroidism, make an appointment with your doctor for an evaluation. Once you've been diagnosed, contact your doctor immediately if you have a seizure or have difficulty breathing, both of which can be complications of hypoparathyroidism.

Tests and diagnosis
A doctor who suspects hypoparathyroidism begins the diagnostic process by taking a medical history and asking about your symptoms, such as muscle cramps or tingling of the extremities. He or she will also want to know whether you've had any recent surgeries, particularly operations involving the thyroid or neck. Next, your doctor will conduct a physical examination, looking for signs that suggest hypoparathyroidism. You'll also undergo blood tests, and the following findings may indicate hypoparathyroidism:
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A low blood-calcium level A low parathyroid hormone level A high blood-phosphorus level A low blood-magnesium level

Your doctor may also order these additional tests:

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Electrocardiogram (ECG). This test involves taking electrical readings of your heart's activity. It can detect arrhythmias associated with hypocalcemia and, in turn, hypoparathyroidism. Urine test. Evaluation of a sample of your urine can show whether your body is excreting too much calcium. X-rays and bone density tests. These can determine whether abnormal calcium levels have affected the strength of your bones.

In diagnosing children, doctors check to see whether tooth development is normal and whether they have met developmental milestones. Doctors who specialize in hormone diseases (endocrinologists) are more familiar with diagnosing and treating hypoparathyroidism, and your general practitioner may make a referral to such a specialist.

People with hypoparathyroidism may develop any of a number of complications. The following complications are due to low calcium levels, and most may improve with adequate treatment:
 A condition called tetany, which is characterized by sensory symptoms consisting of paresthesias (odd, tingling feelings) of your lips, tongue, fingers and feet; cramp-like spasms of your hands and fingers, which may be prolonged and painful; muscle discomfort; and twitches or spasms of the muscles of your face, throat or arms. When these spasms occur in your throat, they could interfere with breathing, creating a possible emergency. Loss of consciousness, with convulsions (grand mal seizures). Malformation of the shape and size of the teeth. Weak bones (osteoporosis). Heart arrhythmias and fainting.

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Other complications are associated with hypoparathyroidism, but will not improve with calcium and vitamin D treatment:
   Stunted growth (short stature) Slow mental development (or mental retardation) in children Cataracts

Treatments and drugs
In choosing treatment for hypoparathyroidism, doctors consider factors such as your symptoms, including their severity, and your overall health. The goal of treatment is to normalize the levels of calcium and phosphorus in your body. A treatment regimen typically includes:
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Oral calcium carbonate tablets. Vitamin D, which can help your body absorb calcium and eliminate phosphorus. The forms of vitamin D called ergocalciferol, dihydrotachysterol

or calcitriol are recommended most often, because they have a longer duration of action or are more potent than are other forms of this vitamin. Often, the required doses of vitamin D are much higher than are those used for a typical daily vitamin supplement. At high doses, calcium supplements can cause gastrointestinal side effects such as constipation in some people. For that reason, take these pills only under the guidance of your doctor. Dietary steps Your doctor may also recommend that you consult a dietitian, who is likely to advise a diet that is:
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Rich in calcium. This includes dairy products, nuts, green leafy vegetables, and fortified orange juice and breakfast cereals. Low in phosphorus-rich items. This means avoiding carbonated soft drinks, which contain phosphorus in the form of phosphoric acid. Dairy products and some nuts also tend to be high in phosphorus.

In some cases, when you need immediate relief of symptoms, your doctor may recommend hospitalization in order to administer calcium by intravenous (IV) infusion. These IV infusions may be important if you're having severe spasms associated with tetany. After hospital discharge, you can continue to take calcium and vitamin D as an oral supplement. Because hypoparathyroidism is a long-lasting (chronic) disorder, treatment strategies are generally recommended for the rest of your life, along with regular blood tests to determine whether calcium in particular is at normal levels. Your doctor will adjust your dose of supplemental calcium if your blood-calcium levels rise or fall. If calcium in your blood remains low, despite treatment, your doctor may add a prescription diuretic medication — specifically, a thiazide diuretic such as hydrochlorothiazide or metolazone. While other types of diuretics (loop diuretics) decrease calcium levels in your bloodstream, the thiazides can increase those levels. Even though these thiazide drugs can raise blood-calcium levels in some people, their effectiveness is not universal. Most people who are treated for hypoparathyroidism can keep their symptoms under good control if they continue to receive treatment long term. This is particularly true with an early diagnosis.

There are no specific actions that you can take to prevent hypoparathyroidism. However, if you're scheduled to undergo thyroid or neck surgery, talk to your surgeon for assurance that steps will be taken to avoid damage to your parathyroid glands during the procedure.

If you've had surgery involving your thyroid or neck, be alert for signs and symptoms that could indicate hypoparathyroidism. When they occur, your doctor may recommend prompt treatment with calcium and vitamin D to minimize the seriousness of the disorder.

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