Updated: 6/18/2021

Hypoparathyroidism

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Questions
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  • Summary
    • Hypoparathyroidism is the decreased production of parathyroid hormone by chief cells of the parathyroid gland most commonly caused by a thyroidectomy that results in decreased plasma calcium levels, increased plasma phosphate levels, and decreased active Vitamin D levels.
    • Diagnosis is made by obtaining serum calcium, phosphate, PTH, and 1,25(OH)2 Vitamin D levels.
    • Treatment is aimed at supplementing vitamin D and calcium levels. There is no current hormone replacement therapy available.
  • Etiology
    • Findings
      • decreased plasma calcium levels
      • increased plasma phosphate levels
      • decreased 1,25(OH)2 Vitamin D levels
    • Etiology
      • iatrogenic
        • thyroidectomy most common cause
    • Pathophysiology
      • decreased PTH levels cause
        • decreased urinary excretion of phosphate at kidneys
          • serum phosphate levels increase
        • decreased conversion of inactive form of vitamin D to active form
          • 1,25(OH)2-vitamin levels decrease
  • Presentation
    • Symptoms
      • hypocalcemia
        • more common in hypoparathyroidism
          • neuromuscular irritability
            • Chvostek's sign
            • seizures
            • tetany
          • cataracts
          • fungal infections of the nail
          • hair loss
          • skin changes
            • vitiligo
            • blotchiness of skin
  • Imaging
    • Radiographs
      • skull
        • basal ganglia calcification
  • Evaluation
    • Labs
      • decreased
        • PTH
        • calcium
        • 1,25-Vit D
        • urinary calcium
      • increased
        • serum phosphate
      • normal
        • alkaline phosphatase
    • pH
      • alkalosis increases albumin binding to ionized calcium
        • leads to hypocalcemia
    • EKG
      • prolonged QT interval
      • Labs associated with various PTH, and Vitamin D anomalies
        Serum Ca
        Serum Phos
        PTH
        Common Cause
        Hyperparathyroidism
        Increased
        Decreased
        Increased
        Adenoma
        Hypoparathyroidism
        Decreased
        Increased
        Decreased
        Thyroidectomy (including parathyroid)
        Ectopic PTH
        Increased
        Decreased
        Decreased
        Malignancy
        Vitamin D malabsorption
        Decreased
        Decreased
        Increased
        Celiac disease, other GI disease
        Hypo Vit D with no phosphate excretion from the kidney
        Decreased
        Increased
        Increased
        Renal failure, pseudo
        hypoparathyroidism
  • Treatment
    • Nonoperative
      • calcium and vitamin D supplementation
        • indications
          • decreased serum calcium level
          • decreased levels of vitamin D
        • outcomes
          • must monitor labs on a regular basis
  • Prognosis
    • No current hormone replacement therapy available
    • Treatment is aimed at supplementing vitamin D and calcium levels
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Questions (1)

(OBQ11.58) A patient with chronic renal disease would expect which of the following endocrine abnormalities?

QID: 3481
1

Decreased production of PTH

10%

(222/2317)

2

No change in production of PTH

2%

(50/2317)

3

Increased production of PTH

87%

(2023/2317)

4

Increased production of TSH

1%

(13/2317)

5

Decreased production of TSH

0%

(5/2317)

L 1 C

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Evidence (2)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (5)
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