Hypoparathyroidism is a rare condition that occurs due to a lack of parathyroid hormone. This condition can cause a variety of symptoms, ranging from fatigue, muscle aches, to seizures.
The parathyroid glands function to regulate and maintain the balance of calcium and phosphorus levels in the body. Everyone has four parathyroid glands which are located in the neck, just behind the thyroid gland .
Hypoparathyroidism occurs when the parathyroid glands don't produce parathyroid hormone in the levels the body needs. This condition can be caused by many things, from side effects of surgery to certain diseases.
Sufferers of hypoparathyroidism generally require lifelong medical care and supervision. The treatment given aims to relieve symptoms and prevent serious complications.
Hypoparathyroid Causes and Risk Factors
As previously explained, hypoparathyroidism occurs as a result of the parathyroid glands not producing enough parathyroid hormone. This condition can be caused by the following:
Surgery on the neck, such as thyroid surgery or surgery for neck tumors, is the most common cause of hypoparathyroidism. This condition can occur due to accidental damage or removal of the parathyroid glands during surgery.
Autoimmune diseases can cause the body to produce antibodies to fight parathyroid tissue which is considered a foreign body that is dangerous. As a result, the parathyroid glands are damaged and stop producing parathyroid hormone.
Hereditary hypoparathyroidism is a condition when a person is born without parathyroid glands or has parathyroid glands with impaired function. An example of this genetic disorder is DiGeorge syndrome .
Low blood levels of magnesium (hypomagnesemia)
Hypomagnesemia will also interfere with the function of the parathyroid glands in producing parathyroid hormone. Low levels of magnesium in the blood can be caused by excessive consumption of alcoholic beverages.
Long exposure to high levels of radiation can damage the parathyroid glands. Radiation given as a treatment, such as radiotherapy, can also cause hypoparathyroidism.
Although it can happen to anyone, hypoparathyroidism is more at risk for someone with the following factors:
- Have a family history of hypoparathyroidism
- Suffer from another hormone-related illness, such as Addison's disease
- Get radiotherapy , especially in the face and neck area
In addition, pregnant women who experience hyperparathyroidism are at risk of giving birth to babies with hypoparathyroidism, especially if the condition is not handled properly.
Symptoms of Hypoparathyroidism
As a result of a lack of parathyroid hormone, sufferers will experience electrolyte disturbances in the form of low levels of calcium (hypocalcemia) and high levels of phosphate (hyperphosphatemia) in the body. This is what causes the symptoms of hypoparathyroidism to appear, such as:
- Tingling or numbness in the fingertips, toes or lips
- Muscle aches or cramps in the feet, legs, stomach or face
- Muscles tighten, like a pull, usually in the mouth, hand, or arm
- Menstrual pain
- Depression or anxiety disorder
- Hair loss
- Skin is dry and feels rough
- Brittle nails
- It's hard to breathe
Meanwhile, hypoparathyroidism that occurs in children can cause symptoms in the form of headaches, vomiting, or teeth that grow late or become porous easily.
When to see a doctor
Immediately see a doctor if you or your child experience the symptoms of hypoparathyroidism mentioned above, especially if the symptoms are accompanied by difficulty breathing or seizures. Early treatment is needed to prevent the condition from getting worse and the emergence of dangerous complications.
If you suffer from an autoimmune disease, a disease related to hormone balance, a genetic disorder, depression, or have a family history of hypoparathyroidism, have regular checkups with your doctor so that these conditions can be monitored.
Diagnosis of Hypoparathyroidism
To diagnose hypoparathyroidism, the doctor will start by asking about the patient's symptoms, history of the disease that the patient and his family members have had, and medical procedures that the patient has undergone.
Next, the doctor will carry out a complete physical examination, including looking at the condition of the skin, hair, and muscle strength. In pediatric patients, the doctor will also check the condition of the teeth.
The doctor will also carry out supporting examinations to confirm the diagnosis and find out the cause of hypoparathyroidism. Investigations can be done with a blood test to see the levels of calcium, phosphorus, and parathyroid hormone in the body. The following is the reference used:
- Normal blood calcium level: 8.5–10.5 mg/dL
- Normal blood phosphorus level: 2.5–4.5 mg/dL
- Normal level of parathyroid hormone: 10–65 ng/L
Someone is considered to suffer from hypoparathyroidism if they have low calcium levels, high phosphorus levels, and low parathyroid hormone levels compared to the above reference.
In addition to blood tests, the doctor can also carry out the following tests to get a more accurate diagnosis:
- Urine test, to see whether there is excess calcium excreted through the urine
- Scanning with a CT scan or MRI, to identify tumors or other structural abnormalities near the parathyroid glands
- X-rays and bone density tests, to see the effect of low calcium on the bones
- Electrocardiogram (EKG), to see heart conditions that can be disrupted due to low calcium levels
Treatment of hypoparathyroidism needs to be carried out for life by the patient to relieve symptoms and prevent complications. This treatment aims to normalize the levels of calcium and phosphorus in the body. The following are some treatment steps that can be taken to treat hypoparathyroidism:
As a first treatment, the doctor can give some of the following medicines:
- Calcium carbonate supplements, to increase blood calcium levels
- Vitamin D, such as calcitriol and alphacalcidol, to help the body absorb calcium and remove excess phosphate
- Magnesium, to increase magnesium levels
- Thiazide diuretics, to reduce the amount of calcium lost in the urine
Parathyroid hormone injections
If the above drugs have not been able to balance calcium and phosphate levels, the doctor will inject parathyroid hormone once a day. However, parathyroid hormone injections are only given to certain patients and under special supervision from a doctor.
Adjusting your diet by consuming more foods that are rich in calcium and low in phosphate or phosphorus can also relieve symptoms of hypoparathyroidism and reduce the risk of complications.
Examples of foods rich in calcium are green leafy vegetables, milk, and food products fortified with calcium, such as cereals or biscuits.
Meanwhile, examples of foods that need to be limited because they contain high phosphorus are red meat, chicken, oats, and cheese with a hard texture, such as parmesan cheese.
Calcium infusions can be given if the patient experiences muscle cramps or muscle tension that is very bothersome. Intake of calcium through an IV can relieve symptoms more quickly because it goes directly into the bloodstream.
After receiving treatment, the patient's condition needs to be monitored by a doctor through routine blood tests. If there is a change in the level of calcium or phosphate in the patient's blood, the doctor may adjust the dosage of the drug.
Early diagnosis and treatment can reduce the risk of hypoparathyroid complications. However, if not handled properly, hypoparathyroidism can cause various complications, such as:
- Cardiac arrhythmia
- Frequent fainting
- Heart failure
- Physical and mental growth is stunted in children
- Impaired kidney function due to calcium buildup in the kidneys
- Kidney stones
- Calcium buildup in the brain which can cause balance problems and trigger seizures
There is no specific way to prevent hypoparathyroidism. However, you can reduce your risk of developing this disease by fulfilling a balanced nutritional intake and adopting a healthy lifestyle, such as exercising diligently and not consuming alcoholic beverages.
In addition, you also need to see a doctor immediately when you experience symptoms of hypoparathyroidism, especially if you have risk factors. Early detection and treatment are very useful to inhibit the development of the disease and prevent complications.
Then, if you are going to have thyroid or neck surgery, consult further with your doctor about the benefits and risks, including the risk of hypoparathyroidism due to this action.