Are you experiencing strange symptoms due to low calcium levels in your body? It could be hypoparathyroidism!

Do you sometimes feel unexplained body aches? Do your limbs go numb? Or do you just feel like your skin is just crawling? One of the reasons for these things could be a condition called hypoparathyroidism, which we are going to talk about today. Don't worry, although this is a rare condition, it can be controlled if it is recognized and treated properly. Let's talk about this in detail.

What is Hypoparathyroidism?

Simply put, hypoparathyroidism is when your blood produces too little or no Parathyroid Hormone (PTH). This hormone is important for regulating the levels of calcium and phosphorus in your body. So, when your PTH levels are low, your blood calcium levels drop – we call this hypocalcemia – and your blood phosphorus levels rise.

This condition is often chronic , meaning it can last a lifetime. However, in some cases, it can also temporarily improve.

So what are these parathyroid glands?

Imagine, in the front of our neck, in the shape of a butterfly, there is the Thyroid Gland. Behind that Thyroid Gland, there are four glands, usually about the size of a small pea. These are called Parathyroid Glands . These are part of the Endocrine System, which produces hormones in our body.

Sometimes these four glands can be located elsewhere in the neck, chest, or even along the esophagus. These are called ectopic parathyroid glands .

The main function of these parathyroid glands is to produce parathyroid hormone (PTH). This PTH is what keeps the calcium level in our blood at the right level.

• If PTH decreases: Calcium in the blood decreases (Hypocalcemia).
• If PTH increases: Calcium in the blood increases (Hypercalcemia).

Not only that, but this PTH hormone also helps control the levels of phosphorus and vitamin D in the blood and bones.

What is calcium? What does it do for our bodies?

Calcium is an essential mineral for our bodies. Did you know that most of the calcium in our bodies is stored in our bones? However, there must also be a certain amount of calcium in the blood.

Let's look at some important things other than calcium in the blood:

• It helps our nervous system function .
• It helps muscles contract and relax . This is what allows us to move our limbs and walk.
• When we have an injury and bleed, it helps the blood clot .
• It is essential for our heart to function properly .

Now you understand how hypocalcemia (low blood calcium) due to hypoparathyroidism can affect many things. Calcium is also needed to keep bones strong. But hypocalcemia is a decrease in calcium in the blood, not a decrease in calcium in the bones.

Can hypoparathyroidism cause electrolyte imbalance?

Yes, absolutely. Calcium and Phosphorus are two types of electrolytes . Electrolytes are minerals that have an electrical charge in our bodies and contribute to many important functions. In hypoparathyroidism, calcium in the blood decreases and phosphorus increases, causing an electrolyte imbalance. It is very important to correct this.

There is one more thing. Magnesium is another important electrolyte. If the level of magnesium in the blood decreases (Hypomagnesemia) , it can also be a cause of hypoparathyroidism. Because magnesium is essential for the parathyroid glands to function properly.

What is the difference between Hypoparathyroidism and Hyperparathyroidism?

These two names are somewhat similar, so they can be confusing. In medicine, the prefix "Hypo" means "less" or "not enough." The prefix "Hyper" means "more" or "higher."

• Hypoparathyroidism: The parathyroid glands do not produce enough parathyroid hormone (PTH), which causes low calcium levels in the blood.
• Hyperparathyroidism: The parathyroid glands produce too much PTH, which causes an increase in calcium in the blood.

Simple, right?

Who gets this condition called hypoparathyroidism?

This can happen to adults as well as young children. But as mentioned before, this is a somewhat rare condition .

• In adults: This is often caused by accidental damage to the parathyroid glands during neck surgery – for example, thyroid surgery.
• For children: This is often caused by a genetic condition called DiGeorge Syndrome in children.

Even in a country like America, this condition is said to affect less than two hundred thousand people. So, in our country, it could be even less.

What are the main causes of hypoparathyroidism?

There are several reasons for this.

• Damage to the parathyroid glands: This is the most common cause. About 75 percent (75%) of patients develop this condition when the glands are accidentally damaged during surgery on the neck or thyroid gland. Sometimes the condition can occur years after surgery. But most often it starts soon after surgery. Hypoparathyroidism caused by this condition is usually temporary, but in some people it can be permanent. Radiation therapy is very unlikely to damage these glands.

• Genetic conditions: Less than ten percent (10%) of cases are caused by genetic conditions. The most common of these is DiGeorge Syndrome . This is a chromosomal genetic condition. Babies born with this syndrome do not have parathyroid glands. So, because they do not produce PTH, they have chronic hypoparathyroidism. About 60% of children with hypoparathyroidism are said to have DiGeorge Syndrome. It can also be caused by other genetic syndromes associated with deafness and kidney disease.

• Autoimmune Diseases: Sometimes our own immune system mistakenly attacks the parathyroid glands. Type 1 autoimmune polyglandular syndrome is one such disease. This causes persistent hypoparathyroidism. It can also be caused by conditions called Addison's disease and pernicious anemia .

• Infiltrative Disorders: In some disease states, substances such as iron (as in hemochromatosis) and copper (as in Wilson's disease) can accumulate in the parathyroid glands. Also, some cancer metastases can impair the function of these glands, causing hypoparathyroidism.

• Low Magnesium Levels: As mentioned earlier, magnesium is essential for the parathyroid glands to function properly. Low levels of magnesium in the blood (hypomagnesemia) can lead to hypoparathyroidism. This is called functional hypoparathyroidism . This condition usually resolves when magnesium levels are restored.

What are the symptoms of hypoparathyroidism?

Often, this condition develops very slowly. Therefore, the symptoms can be very subtle. Some people don't even know they have the condition for years.

These are the symptoms that can be seen in general:

• Tingling in the lips, fingertips, and toes.
• Muscle cramps. Do you remember sometimes having leg cramps at night? Things like that, but if they happen frequently, it could be a symptom of calcium deficiency.
• Muscle spasms (Tetany).
• Abdominal pain.
• "Brain fog" is a condition where you have difficulty concentrating and feel a little disoriented.
• Heartbeat irregularities (Arrhythmia).
• Brittle nails.
• Dry hair and dry, scaly skin.
• The appearance of cataracts.
• Weakening of tooth enamel in children.

How do doctors recognize this condition?

Hypoparathyroidism is usually suspected and confirmed when tests show that a person's blood calcium and parathyroid hormone (PTH) levels are low.

Because the symptoms are so subtle, doctors sometimes discover this condition "incidentally." That is, they only start looking for it when they see low calcium in the blood during a routine blood test for another condition.

If a person is confirmed to have low PTH hormone and calcium levels in their blood twice within six months, it is considered chronic hypoparathyroidism .

What kind of tests are done for this?

If you have these symptoms, your doctor will do a physical exam and ask about your symptoms, family medical history, and medications you take.

In addition, one or more of the following tests may be performed:

• Parathyroid hormone (PTH) blood test.
• Calcium blood test.
• Phosphorus blood test.
• Magnesium blood test.
• A 24-hour urine test: This measures how much calcium is excreted in the urine.

Sometimes, your doctor may order further tests to check for more serious side effects that may be caused by this condition. For example:

• Electrocardiogram (ECG or EKG): Checks for heart rhythm irregularities.
• Computed tomography (CT) scan: Checks for calcium deposits in the brain (Brain Calcifications).

How is this treated?

The main goal of treatment for hypoparathyroidism is to reduce symptoms and restore the levels of calcium and other minerals in your body to the correct levels.

The following can be done as treatment:

• Calcium Carbonate and Vitamin D Supplements: Many people with hypoparathyroidism will need to take calcium and vitamin D in pill or liquid form throughout their lives. This is the main and first line of treatment for this condition. Vitamin D is essential for our bodies to absorb calcium properly. Therefore, if you have hypoparathyroidism, you will need to take both of these supplements.
• A diet high in calcium and low in phosphorus: Your doctor may advise you to eat more calcium-rich foods (milk, cheese, yogurt, green vegetables) and reduce foods high in phosphorus (processed meats, drinks like cola). However, since it's difficult to get enough calcium from food alone, taking supplements may be necessary.
• Parathyroid hormone (PTH) injections: If calcium and vitamin D supplements alone do not control your condition, your doctor may decide to give you parathyroid hormone (PTH) injections.

Are there any side effects of the treatment?

Yes, sometimes if the amount of vitamin D and calcium given as treatment is too high, the calcium level in the blood can become too high. This is called hypercalcemia . This is also harmful to the body. Therefore, you need to have regular blood tests to see if your treatment is working properly and your calcium level is correct.

There is a very small risk of developing a type of bone cancer called osteosarcoma with long-term use of parathyroid hormone (PTH) injections. Therefore, doctors recommend this injection only in very serious cases, when other treatments have not been successful.

What are the risk factors for this condition?

There are several factors that increase the risk of developing hypoparathyroidism:

• Having had recent neck or thyroid surgery.
• Family history of parathyroid gland diseases.
• Having certain autoimmune diseases that affect the endocrine system, such as Addison's disease.

What is the prognosis of this condition?

The outlook for hypoparathyroidism is generally good, especially if the condition is recognized early and proper treatment is initiated.

However, if this condition causes things like cataracts, brain calcifications, and dental changes, they are difficult to reverse. That's why early detection is important.

How long will this situation last?

Most of the time, hypoparathyroidism is a chronic condition, meaning it lasts a lifetime. However, hypoparathyroidism can also be temporary due to certain causes (e.g., magnesium deficiency, temporary after surgery).

What are the complications that can arise from this?

If hypoparathyroidism is not treated properly, various long-term complications can occur:

• Kidney function issues.
• Kidney stones.
• Cataracts.
• Calcium deposits in various parts of the brain.

This condition, especially in children, can cause complications such as:

• Poor growth.
• Dental issues.
• Slow mental development.

It is very important to note that if the calcium level in the blood suddenly and severely decreases (Acute Hypocalcemia), if not treated promptly, it can lead to life-threatening conditions such as seizures and difficulty breathing due to laryngeal spasms . If you experience these symptoms (e.g., severe muscle twitching, convulsions), you should go to the nearest hospital immediately.

When should you see a doctor?

• If you have symptoms that you think may be hypoparathyroidism, be sure to see a doctor.
• If you have already been diagnosed with hypoparathyroidism, you should have your blood calcium levels checked at regular intervals as directed by your doctor to ensure that you are receiving the correct treatment.
• As mentioned earlier, if you experience symptoms of acute hypocalcemia, such as sudden severe muscle twitching or seizures , go to the nearest hospital immediately.

The most important things you need to remember (Take-Home Message)

Hypoparathyroidism is a rare condition, but it is treatable and manageable . The symptoms can sometimes be subtle and difficult to recognize. Therefore, it is important to tell your doctor if you have any risk factors for this condition (for example, if you have recently had neck surgery or if someone in your family has parathyroid disease).

A few simple blood tests can check your parathyroid hormone (PTH) and calcium levels. If you recognize this condition early, you can start the right treatment, prevent complications, and live a healthy life. So, don't panic, but be aware of this. If you have any concerns, don't hesitate to talk to your doctor.

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