Hypoparathyroidism

Signs and Symptoms

Most symptoms of hypoparathyroidism result from having too little calcium in the blood. Signs include the following:

• Muscle spasm or cramping, typically in hands or feet (tetany)
• Hair loss
• Dry skin or malformed nails
• Numbness, tingling, or burning, especially around the mouth and fingers
• Candidiasis (yeast infection)
• Seizures

The following signs and symptoms often appear in children with hypoparathyroidism:

• Poor tooth development
• Vomiting
• Headaches
• Mental deficiency

What Causes It?

There are a number of causes of hypoparathyroidism:

• Underdeveloped or missing parathyroid glands at birth
• Medical treatment (radiation to thyroid gland, drug treatment, thyroid or parathyroid surgery)
• An underlying medical condition such as cancer, neck trauma, Addison disease, Wilson's disease, too much iron in tissues, low levels of magnesium

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing hypoparathyroidism:

• Family history of parathyroid disorder
• Thyroid or neck surgery
• Taking medications that suppress the parathyroid gland
• Surgery or removal of the parathyroid gland
• Autoimmune condition

What to Expect at Your Provider's Office

Your health care provider will check for muscle spasms, twitching, and seizures and examine your skin for problems, such as dry skin, thinning hair, and fungal infections. In children, the health care provider will ask about and check for tooth formation and developmental progress. Your health care provider may also order blood tests to check levels of calcium, phosphate, magnesium, and parathyroid hormone.

Treatment Options

Prevention

There is no way to prevent inherited hypoparathyroidism. Thyroid and parathyroid surgery once resulted in damage to parathyroid glands, often causing hypoparathyroidism. Today's surgical techniques, however, make this much less likely.

Treatment Plan

The main treatment for hypoparathyroidism is aimed at restoring the levels of calcium in the body. If you have hypoparathyroidism, you will probably have to take calcium and vitamin D (which is required for the body to absorb calcium) supplements for the rest of your life. To treat tetany (muscle spasms), calcium will be given intravenously (IV). Your doctor may also prescribe diuretics (water pills) to prevent losing too much calcium in the urine and to reduce the amount of calcium and vitamin D needed.

It is important to get regular checkups so your doctor can monitor the levels of calcium and phosphorus in your blood over time.

Complementary and Alternative Therapies

Calcium and vitamin D supplements are the main treatment for hypoparathyroidism. Your doctor will prescribe the right dose based on your blood tests. Do not change your dose without your doctor's supervision. Your doctor will also recommend taking calcium in divided doses several times a day, to help your body absorb it properly.

Following these nutritional tips may help reduce symptoms of hypoparathyroidism. Do not take supplements without your doctor's supervision.

• Eliminate all potential food allergens, including dairy, wheat (gluten), soy, corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale). Discuss your diet with your doctor to make sure you are getting the appropriate amounts.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy), or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine.
• Limit carbonated beverages. They are high in phosphates, which can leach calcium from your bones.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Drink soy milk, for bone health unless allergic to soy.
• Exercise moderately at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
• Ipriflavone (soy isoflavones) standardized extract, 200 mg 3 times a day, for bone loss. Ipriflavone can interfere with many different medications and may not be suitable for certain people with immune deficiencies.
• Omega-3 fatty acids, such as fish oils, 1 - 2 capsules or 1 - 2 tablespoonfuls of oil daily, to help decrease inflammation and support healthy metabolism. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning drugs, such as warfarin (Coumadin) and aspirin.

Foods rich in calcium include:

• Almonds
• Legumes
• Dark leafy greens
• Blackstrap molasses
• Oats
• Sardines
• Tahini
• Prunes
• Apricots

Your doctor may recommend you take calcium with a glass of orange juice; some forms of calcium are better absorbed in an acidic environment. You can also add acid to your diet by squeezing lemon juice over leafy greens.

Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

Chaste tree (Vitex agnus castus) standardized extract, 20 - 40 mg daily before breakfast, for support of the parathyroid gland. Chaste tree can interact with many medications, particularly hormonal medication, as well as some hormonal conditions; speak with your physician.

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of hypoparathyroidism based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Calcarea carbonica (calcium carbonate)
• Calcarea phosphorica (calcium phosphate)

Prognosis/Possible Complications

If hypoparathyroidism is diagnosed early, the prognosis is good. If it is not diagnosed early, complications may occur, including:

• Acute muscle spasms leading to breathing problems
• Cataracts
• Muscle, ligament, and nervous system disorders
• Stunted growth, tooth malformations, and intellectual disability in childhood

Following Up

People with hypoparathyroidism require lifelong monitoring by a health care provider.

Supporting Research

Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA. 2001;285:1482-8.

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1252-1253.

Brown E. Anti-Parathyroid and Anti-Calcium Sensing Receptor Antibodies in Autoimmune Hypoparathyroidism. Endocrinology and Metabolism Clinics. 2009;38(2).

Kliegman: Nelson Textbook of Pediatrics, 18th ed. Philadelphia, PA. Saunders Elsevier. 2007.

Lydeking-Olsen E. Beck-Jensen JE, Setchell KD, Holm-Jensen T. Soymilk or progesterone for prevention of bone loss -- a 2 year randomized, placebo-controlled trial. Eur J Nutr. 2004;43(4):246-57.

Rubin MR, Dempster DW, Zhou H, Shane E, Nickolas T, Sliney J, Silverberg SJ, Bilezikian JP. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res. 2008;23(12):2018-34.

Stuckey BG, Lim EM, Kent GN, Ward LC, Gutteridge DH. Bisphosphonate therapy for Paget's disease in a patient with hypoparathyroidism: profound hypocalcemia, rapid response, and prolonged remission. J Bone Miner Res. 2001 Sep;16(9):1719-23.

Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlove-Wuttke D. Chaste tree (Vitex agnus-castus) -- pharmacology and clinical indications. Phytomedicine. 2003;10(4):348-57.