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Updated: Jun 18 2021

Hypoparathyroidism

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Images
https://upload.orthobullets.com/topic/9028/images/basal ganglia calcification.jpg
https://upload.orthobullets.com/topic/9028/images/prolonged qt.jpg
  • 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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