What is Hypoparathyroidism?
Hypoparathyroidism is a rare endocrinological disorder caused by insufficient production of parathyroid hormone (PTH) by the four small parathyroid glands located on the back of the thyroid gland in the neck.
These glands are responsible for regulating the body’s calcium and phosphate balance. PTH increases calcium release from bones, promotes calcium absorption in the intestines, and ensures calcium reabsorption in the kidneys.
When the parathyroid glands cannot secrete enough PTH, blood calcium levels drop (hypocalcemia), and phosphorus levels rise (hyperphosphatemia). This condition leads to a disturbance in calcium metabolism and a shift in the blood’s calcium balance, which is crucial for basic bodily functions.
What Causes Hypoparathyroidism?
Hypoparathyroidism can have many different causes; from congenital genetic problems to surgeries, immune system issues, and mineral imbalances, various factors can lead to this condition. The main causes of this condition are:
- Hereditary Causes: Congenital Hypoparathyroidism
Some people are born with hypoparathyroidism due to congenital genetic problems. Certain specific genes in our body play an important role in the development and function of the parathyroid glands. Changes (mutations) in these genes can prevent the proper development or function of the glands.
- Problems with the GCM2 gene: This gene is crucial for the formation of the parathyroid glands. If there is a problem with this gene, the glands may not develop at all or may not develop sufficiently.
- Problems with the PTH gene: This gene directly produces parathyroid hormone. If there is a problem with this gene, the body may not be able to produce enough of this hormone.
- Problems with the CASR gene: This gene regulates the secretion of parathyroid hormone by sensing calcium levels in the blood. If there is a problem with this gene, the calcium balance can be disrupted, and hypoparathyroidism can occur.
Furthermore, some genetic disorders, such as DiGeorge Syndrome, can lead to missing or underdeveloped parathyroid glands. Familial isolated hypoparathyroidism is a hereditary condition caused by problems in the genes mentioned above, and it does not involve other health problems.
Hypoparathyroidism can be passed down genetically in families. For individuals with a family history of this condition, genetic counseling under the guidance of Uzm. Dr. Burcu Meryem Atak Sançmış is the right step for a healthy life.
- Later Causes: Hypoparathyroidism Developing Due to Surgeries and Other Factors
- Surgeries: Especially during thyroid or parathyroid gland surgeries, the parathyroid glands can be accidentally injured or removed. This is one of the most common causes of hypoparathyroidism. It is an expected complication after surgery, and close patient follow-up can help reduce this risk. It generally resolves within 6-12 months but can also be permanent.
- Radiation Therapy: Radiation therapy in the neck area (e.g., for cancer treatment) can damage the parathyroid glands and lead to hypoparathyroidism. Protective measures during radiation can help reduce this risk.
- Certain Medications: Some chemotherapeutic agents can indirectly affect parathyroid gland function by lowering magnesium levels in the body, causing hypoparathyroidism.
- Immune System Problems: Autoimmune Hypoparathyroidism
Sometimes, the body’s defense system (immune system) mistakenly attacks its own tissues, in this case, the parathyroid glands. This condition is called an autoimmune disease. In certain conditions like autoimmune polyendocrinopathies, the immune system can attack the parathyroid glands along with other hormone-producing organs, leading to hypoparathyroidism.
- Magnesium Imbalance
Magnesium levels in our blood that are too low or too high can impair the proper function of the parathyroid glands and affect hormone production. In particular, low magnesium levels can make it difficult for parathyroid hormone to be secreted and lead to hypocalcemia. Therefore, a healthy magnesium balance in our body is important for proper parathyroid gland function.
- Other Diseases: Disruption of Parathyroid Gland Structure
Certain diseases such as hemochromatosis (excessive iron accumulation in the body) and Wilson’s disease (excessive copper accumulation in the body) can infiltrate the parathyroid glands, disrupt their structure, and thus impair their functions, leading to hypoparathyroidism.
Correctly determining the etiology of hypoparathyroidism is crucial for the effectiveness of the treatment process. Uzm. Dr. Burcu Meryem Atak Sançmış assesses the underlying causes of the disease in detail and ensures a safe and effective management of the process with individualized treatment plans.
What Are the Symptoms of Hypoparathyroidism?
- Early Symptoms:
- Tingling or numbness in the fingertips, toes, and lips.
- Muscle cramps and spasms.
- Severe Symptoms:
- Prolonged and painful muscle contractions (tetany).
- Seizures.
- Heart rhythm disturbances (arrhythmias).
- Difficulty breathing (laryngospasm).
- Long-Term Symptoms (untreated):
- Cataracts (clouding of the eye lens).
- Dental problems (enamel structure disorders).
- Neurological problems due to calcium deposits in the brain (basal ganglia calcification).
How Is Hypoparathyroidism Diagnosed?
The correct diagnosis of hypoparathyroidism is possible through the combined evaluation of clinical findings, laboratory analyses, and, if necessary, imaging techniques. The diagnostic process includes the following steps:
- Comprehensive Medical History:
- Detailed questioning about the patient’s current complaints and symptoms.
- Investigation of family history of hypoparathyroidism or similar endocrine disorders.
- Determination of recent neck surgery (thyroid, parathyroid, etc.) or radiation therapy.
- Inquiry about co-existing autoimmune diseases or other health problems.
- Review of medications and supplements being used.
- Physical Examination:
- Assessment of physical findings that may indicate hypocalcemia (dry skin, brittle nails, muscle cramps, signs of tetany such as Chvostek’s and Trousseau’s signs).
- Laboratory Tests (form the basis of diagnosis):
- Serum Calcium Level Measurement: Confirmation of low calcium levels is crucial for diagnosis and is usually confirmed by repeated measurements.
- Parathyroid Hormone (PTH) Level Measurement: A low or inappropriately low PTH level in the presence of low calcium levels supports hypoparathyroidism.
- Serum Phosphorus Level Measurement: In hypoparathyroidism, phosphorus levels are typically high while calcium is low.
- Serum Magnesium Level Measurement: Evaluated as magnesium deficiency can cause or worsen hypoparathyroidism.
- Urine Calcium Level Measurement: May be performed to assess the amount of calcium excreted by the kidneys and to rule out other causes.
- Alkaline Phosphatase Level Measurement: Can provide additional information about bone metabolism.
- Kidney Function Tests: Performed to rule out kidney problems that can affect calcium and phosphorus balance.
- Imaging Techniques (in selected cases):
- Neck Ultrasound: Can be helpful to assess the structure of the parathyroid glands and potential abnormalities (e.g., postoperative remnants).
- Computed Tomography (CT): May be required in rare cases to assess more detailed structural abnormalities or other possible causes (e.g., calcifications) in the neck area.
- Genetic Testing (especially in hereditary cases):
- Can be performed in early-onset cases, cases with a family history, or suspected specific genetic syndromes to identify the underlying genetic mutations
What Are the Treatment Options for Hypoparathyroidism?
The treatment of hypoparathyroidism is a process that requires individualized approaches. Treatment methods are determined according to the patient’s current condition and needs. Under the guidance of Uzm. Dr. Burcu Meryem Atak Sançmış, the basic methods for treating hypoparathyroidism can be listed as follows:
- Calcium Supplements: The basis of hypoparathyroidism treatment is the rapid regulation of blood calcium levels. Calcium carbonate or calcium citrate tablets are usually the preferred supplements. The daily calcium requirement can vary between 1000 and 3000 mg depending on the patient’s condition. The dosage is adjusted individually through regular blood tests.
- Active Vitamin D Supplements: To improve calcium absorption in the intestines, active vitamin D supplements are recommended. The most commonly used active vitamin D form is calcitriol. The dose of this supplement can initially range from 0.25 to 1.0 micrograms/day and is adjusted to calcium levels.
- Magnesium Supplements: Sufficient magnesium levels are very important for the effective function of parathyroid hormone. Low magnesium levels can worsen hypocalcemia. Therefore, in patients with magnesium deficiency, supplements such as magnesium oxide or magnesium citrate may be recommended.
- Parathyroid Hormone Replacement (rhPTH): In patients who do not achieve sufficient results with calcium and vitamin D supplements, injections of synthetic parathyroid hormone (rhPTH) are used. Especially in severe and uncontrolled cases of hypoparathyroidism, this treatment option can help stabilize patients’ calcium levels. Long-acting PTH prodrugs aim to ensure stable calcium levels with a single daily dose. Our specialist emphasizes the effectiveness of this treatment for chronic hypoparathyroidism.
- Thiazide Diuretics: Thiazide diuretics can be used particularly in patients with excessive calcium excretion in the urine. These diuretics can increase calcium reabsorption in the kidneys, thereby raising blood calcium levels. Generally, medications such as hydrochlorothiazide are used, and the dosage is determined individually.
- Regular Monitoring: During the treatment process, regular monitoring of calcium, phosphorus, and magnesium levels is very important. These tests are used to assess the effectiveness of treatment and to make dose adjustments if necessary. The frequency of monitoring can vary depending on the patient’s condition; it can be weekly, monthly, or at longer intervals.
- Surgical Interventions: If there is a surgical cause, for example, due to the removal of parathyroid glands, surgical interventions may be necessary. In such cases, interventions to restore parathyroid gland function are explored. However, such treatment methods are currently more in the experimental stage and require further research for clinical application.
Lifestyle Management for Hypoparathyroidism
Lifestyle changes play an important role in supporting the treatment process of hypoparathyroidism. Uzm. Dr. Burcu Meryem Atak Sançmış emphasizes how patients can improve their treatment process through lifestyle changes while guiding hypoparathyroidism treatment.
- Dietary Changes:
- Regular consumption of calcium-rich foods (dairy products, green leafy vegetables, fortified foods) is recommended. Also, it is beneficial to avoid phosphorus-rich foods (sodas, processed foods) to ensure calcium balance.
- Exercise:
- Regular exercise is important to maintain bone health and support calcium balance. It is recommended to engage in at least 150 minutes per week of moderately intense exercise.
- Stress Management:
- Stress can worsen the symptoms of hypoparathyroidism. Stress management techniques such as yoga, meditation, and deep breathing exercises can help alleviate symptoms.
Frequently Asked Questions
What should patients with hypoparathyroidism pay attention to in the long term?
Does thyroid surgery increase the risk of hypoparathyroidism?
Does hypoparathyroidism in children differ from that in adults?
How does hypoparathyroidism affect bone health?
Can a woman with hypoparathyroidism become pregnant?
What are the advantages of new treatment methods?
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