Materiały źródłowe

• #1 Hypoparathyroidism: diagnosis, management and emerging therapies | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-024-01075-8

  Hypoparathyroidism is a biochemical diagnosis based on the confirmation of hypocalcaemia in association with a low or inappropriately normal PTH level. […] PTH replacement therapy is now possible with palopegteriparatide, which provides a valuable management option for addressing symptomatic hypocalcaemia and might also reduce the long-term complications of hypoparathyroidism. […] The aetiology of hypoparathyroidism can be divided into surgical causes (7580% of cases) and non-surgical causes (2025% of cases). […] Conventional treatment of hypoparathyroidism with oral calcium salts and active vitamin D can cause fluctuating serum levels of calcium and can exacerbate hyperphosphataemia and hypercalciuria. Conventional therapy has not consistently been shown to improve quality of life.

• #1 Hypoparathyroidism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23275

  Hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. Other findings that support this diagnosis include elevated serum phosphorus, decreased 1,25-dihydroxyvitamin D, and elevated urinary fractional calcium excretion levels. […] Once hypomagnesemia has been excluded, hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. Other laboratory studies are also utilized to help exclude differential diagnoses and support a hypoparathyroidism diagnosis. […] A decreased corrected calcium in conjunction with a reduced or undetectable PTH level on 2 different serum tests at least 2 weeks apart confirms the diagnosis; therefore, these and some other supportive laboratory tests are recommended when assessing patients for PTH deficiency.

• #1 Hypoparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381

  To diagnose hypoparathyroidism, your health care provider will discuss your medical history and do a physical exam, and may suggest blood and urine tests. […] These blood test results might suggest hypoparathyroidism: A low blood-calcium level, A low parathyroid hormone level, A high blood-phosphorus level. […] A urine test can tell whether your body is getting rid of too much calcium. […] Your health care provider may request additional tests, such as other blood tests or a test to check heart rhythm (electrocardiogram, ECG). […] Your health care provider will regularly check your blood to monitor levels of calcium and phosphorus. At first, these tests will probably be weekly to monthly. Eventually, you’ll need blood tests just twice a year. Regular testing allows adjustment of your supplemental calcium dose if your blood-calcium levels rise or fall. […] Because hypoparathyroidism is usually a long-lasting disorder, testing and treatment generally is lifelong.

• #1 Hypoparathyroidism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/parathyroid-disorders/hypoparathyroidism

  Hypoparathyroidism is a deficiency of parathyroid hormone often caused by an autoimmune disorder or by iatrogenic damage or removal of the parathyroid glands during thyroidectomy or parathyroidectomy. […] Measurement of levels of parathyroid hormone are needed for diagnosis. […] Diagnosis is made by finding low or even low-normal PTH concentrations in a patient with hypocalcemia.

• #1 Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10118685/

  Hypoparathyroidism is suspected on clinical grounds, but its diagnosis is based on laboratory tests indicating inappropriately low PTH levels in the presence of hypocalcemia. […] The treatment of hypoparathyroidism is focused on correcting hypocalcemia and hyperphosphatemia, reducing symptoms, and preventing chronic complications. […] The treatment goal is to maintain the patient asymptomatic with a total calcium level close to the lower limit of the normal range, with the administration of active vitamin D and calcium salts. […] The chronic complications of hypoparathyroidism are related to the disease progression and its treatment and include renal, ocular, cardiovascular, bone, and neuropsychiatric manifestations. Monitoring these complications is recommended.

• #1 Hypoparathyroidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441899/

  Hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. […] Hypoparathyroidism treatment primarily consists of correcting calcium, vitamin D, and magnesium deficiencies with supplementation. […] Hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. Other findings that support this diagnosis include elevated serum phosphorus, decreased 1,25-dihydroxyvitamin D, and elevated urinary fractional calcium excretion levels. […] Once hypomagnesemia has been excluded, hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. Other laboratory studies are also utilized to help exclude differential diagnoses and support a hypoparathyroidism diagnosis. […] A decreased corrected calcium in conjunction with a reduced or undetectable PTH level on 2 different serum tests at least 2 weeks apart confirms the diagnosis; therefore, these and some other supportive laboratory tests are recommended when assessing patients for PTH deficiency.

• #1 Hypoparathyroidism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/132

  1st investigations to order include serum calcium, plasma intact PTH, serum albumin, serum magnesium, serum 25-hydroxyvitamin D, serum phosphorus, serum creatinine, and ECG. […] Investigations to consider include 24-hour urine calcium, creatinine, 24-hour magnesium, creatinine, liver function tests, arterial blood gases (ABGs), serum free thyroxine, thyrotropin, morning cortisol and adrenocorticotrophin (ACTH) stimulation testing, full blood count, serum iron, transferrin, ferritin, serum copper, ophthalmological examination, audiology, renal imaging, autoantibodies to type 1 interferon or 21-hydroxylase, and gene sequencing.

• #1

  https://www.healio.com/clinical-guidance/hypoparathyroidism/diagnostic-workup-presentation-and-diagnosis

  Hypoparathyroidism is diagnosed biochemically, with hypocalcemia and low or inappropriately normal parathyroid hormone (PTH) levels representing the hallmark features of the disease. A formal diagnosis of hypoparathyroidism (hypoPT) requires the concomitant occurrence of both of the following: […] two episodes of hypocalcemia at least 2 weeks apart; and […] an undetectable, low or inappropriately normal PTH level. […] The level of PTH is measured by automated immunoassay methods of different generations. […] For the diagnosis of hypoPT, only second- or third-generation assays should be used. […] In the context of hypocalcemia and a low or inappropriately normal PTH, additional biochemical abnormalities which support the diagnosis include the following: […] high-normal or elevated serum phosphate levels; […] low or low-normal circulating concentrations of active vitamin D (calcitriol); […] low or low-normal circulating concentrations of bone turnover markers; and […] elevated fractional excretion of calcium.

• #1 Hypoparathyroidism: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/122207-overview

  Hypoparathyroidism is a condition of parathyroid hormone (PTH) deficiency. Primary hypoparathyroidism, the subject of this article, is a state of inadequate PTH activity; this syndrome results from iatrogenic causes or one of many rare diseases. In the absence of adequate PTH activity, the ionized calcium concentration in the extracellular fluid falls below the reference range. […] Laboratory tests in the workup of hypoparathyroidism include parathyroid and hormone studies, with primary hypoparathyroidism being defined by a low concentration of PTH with a concomitant low calcium level. […] Measurement of 25-hydroxy vitamin D is important to exclude vitamin D deficiency as a cause of hypocalcemia; in this situation, PTH levels will be high. […] Serum magnesium is measured because hypomagnesemia may cause PTH deficiency and subsequent hypocalcemia. […] Serum phosphorus levels are tested because PTH is a phosphaturic hormone; in its absence, phosphorus levels in the blood rise.

• #1 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Diagnosing hypoparathyroidism (investigations) The diagnosis of hypoparathyroidism requires confirmed hypocalcaemia in the presence of undetectable or inappropriately low levels of endogenous PTH and the absence of hypomagnesaemia. Hypomagnesaemia, along with iron or copper overload, are reversible causes of hypoparathyroidism. […] Blood tests (to exclude other causes of hypocalcaemia): Calcium, phosphate, PTH and alkaline phosphatase: Typical blood test results in hypoparathyroidism: Low serum calcium. High serum phosphate. Low PTH. Normal alkaline phosphatase. Typical blood test results in pseudohypoparathyroidism: Low serum calcium. High or normal PTH. […] UEs: to exclude chronic kidney disease. 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3: to exclude vitamin D deficiency as a cause of hypocalcaemia. 25-hydroxyvitamin D3 is normal in hypoparathyroidism and pseudohypoparathyroidism but 1,25-dihydroxyvitamin D3 is low because PTH is not available for its activation.

• #1 Diagnosing and Monitoring Patients with Hypoparathyroidism

  https://www.knowhypopara.com/identify-consequences/diagnosis-and-monitoring/

  DIAGNOSIS AND MONITORING […] Diagnosis and Monitoring Involve Symptomology as Well as Lab Values […] Serum calcium: levels below the lower limits of normal range confirmed on ≥ 2 measures help establish the diagnosis […] Serum PTH: low or inappropriately normal levels (ie, < 20 pg/mL) in the presence of hypocalcemia on ≥ 2 measures help establish the diagnosis [...] Serum phosphate: levels in the upper normal or obviously elevated range may be helpful in diagnosis and evaluation [...] 24-hour urinary calcium excretion: used along with estimated or calculated GFR and biochemical nephrolithiasis risk profile (if clinically warranted) [...] Patient-reported outcome measures [...] Medical and family history [...] Physical examination [...] Target-organ imaging [...] Genetic testing [...] Guidelines recommend performing target-organ imaging, such as a renal ultrasound and a CT scan, at diagnosis and regularly throughout the course of the disease.

• #1 Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10118685/

  To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. […] An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil. […] The objective of this document is to answer routine questions and serve as a guideline for endocrinologists and clinicians in Brazil. […] The diagnosis of hypoparathyroidism should take into account the presence of suggestive clinical manifestations, history of surgery or cervical irradiation, and factors that might suggest the etiology of the disease, such as concomitant autoimmune conditions or syndromic manifestations. […] The laboratory evaluation must include serum measurement of total calcium corrected for albumin, PTH, phosphorus, magnesium, creatinine, and 25(OH)D, in addition to 24-hour urinary calcium.

• #1 Diagnosing HypoPT

  https://www.webmd.com/women/hypoparathyroidism-diagnosis-tests

  A health care professional will check your blood to determine your levels of calcium, PTH, phosphorus, magnesium, and albumin. […] A urine test will let the doctor know how much calcium the kidneys are releasing. […] This test is an X-ray that can see the strength of your bones and help determine your risk of fractures. […] This test can tell if you have an abnormal heart rhythm. […] Your doctor may order this test to see if you have calcium built up in your brain. […] A simple physical exam can give your doctor more insight to see if you have hypoparathyroidism. […] Your doctor may ask about your personal health history as well as past neck surgery or other endocrine disease.

• #1 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Additional blood tests: If an autoimmune process is suspected, look for co-inciding thyroid and adrenal insufficiency: Thyroid-stimulating hormone (TSH), thyroxine and thyroid autoantibodies. Adrenocorticotrophic hormone (ACTH) and adrenal antibodies. […] Urine tests: 24-hour urinary calcium is usually low. Other possible investigations: ECG: prolonged QT interval which may progress to ventricular fibrillation or heart block. Echocardiogram: cardiac abnormalities (in DiGeorge’s syndrome). Renal ultrasound: looking for renal calculi. Hand radiography: looking for shortened metacarpals. Brain MRI scan: basal ganglia calcification (sign of a long-standing hypocalcaemic state). Genetic studies: as appropriate. […] […] […] Symptoms of hypoparathyroidism (presentation) This is essentially with the symptoms of hypocalcaemia. Hypocalcaemia typically presents as perioral numbness, paresthesia, neurocognitive deficits, weakness and carpopedal muscle spasms. Life-threatening complications, such as cardiac arrhythmias, laryngeal spasm, tetany and seizures, can also occur.

• #1 Diagnosis of hypopara – Parathyroid UK

  https://parathyroiduk.org/hypoparathyroidism/diagnosis-of-hypopara/

  Genetic testing is available for inherited forms of hypoparathyroidism. Genetic counseling can help families understand the condition’s impact. […] Additional tests may be recommended to identify the cause of hypoparathyroidism, including: Hand X-rays: To detect shortened bones associated with pseudohypoparathyroidism, Echocardiogram: To identify heart abnormalities linked to DiGeorge syndrome, Genetic Studies: For suspected inherited causes, Autoimmune Tests: If an autoimmune cause is suspected, further blood tests may be done, including thyroid function tests.

• #1 Diagnosis of hypopara – Hypopara UK

  https://www.hypopara.org.uk/diagnosis-of-hypopara/

  Your doctor may also inflate a blood pressure cuff around the lower part of your arm. If your calcium levels are low because of hypoparathyroidism, this can lead to carpopedal spasm. This may be painful so don’t allow this check to be done unless really necessary. You are not a guinea pig! […] Your eyes may be checked for cataracts which can be a complication of hypoparathyroidism. […] Your muscle reflexes may be checked. This is a painless examination done by tapping the tendons of the muscles, for example, at the knee or the elbow. It is done using a special instrument called a tendon hammer. If your calcium levels are low due to hypoparathyroidism, these reflexes can be much more forceful than normal. […] Genetic conditions can’t be prevented but genetic testing is available in centres around the UK. Genetic counselling aims to help parents understand how the condition may affect their family and enable them to make informed decisions.

• #1 Diagnosis of hypopara – Parathyroid UK

  https://parathyroiduk.org/hypoparathyroidism/diagnosis-of-hypopara/

  Diagnosis of Hypoparathyroidism […] How is Hypoparathyroidism Diagnosed? […] Hypoparathyroidism is primarily diagnosed through a calcium blood test. Key findings include: Low blood calcium, High blood phosphate, Low parathyroid hormone (PTH) levels. […] A bone scan and kidney scan are typically requested during the initial appointment. […] A 24-hour urine test is often required. This test involves collecting urine over a 24-hour period, so it requires some planning. […] During an examination, your doctor may look for the following signs: Chvostek’s Sign: Tapping in front of the ear may cause facial twitching if calcium levels are low, Carpopedal Spasm: Inflating a blood pressure cuff may trigger painful muscle spasms in the hands and feet, Cataracts: Your eyes may be checked for cataracts, which can be a complication, Reflexes: Hyperactive reflexes may be present, detected by tapping tendons (e.g., knee or elbow) using a tendon hammer.

• #1 Hypoparathyroidism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/132

  Definitions of permanent postsurgical hypoparathyroidism vary. […] Persistently low intact PTH levels in the presence of hypocalcemia requiring treatment for at least 6 months (some guidelines state at least 12 months) post-procedure generally indicates that the condition is permanent. […] Key diagnostic factors include history of thyroid, parathyroid, or laryngeal surgery, chronic alcoholism, malnutrition, malabsorption, diarrhea, muscle twitches, spasms, cramps, paresthesias, numbness, tingling, poor memory, slowed thinking, Chvostek sign, convulsions, irregular heart beat, tachycardia, and Trousseau sign. […] Diagnostic tests include serum calcium, plasma intact PTH, serum albumin, serum magnesium, serum 25-hydroxyvitamin D, serum phosphorus, serum creatinine, and ECG.

• #1 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Hypocalcaemia may be an asymptomatic laboratory finding or a life-threatening metabolic disturbance. Symptoms include: Muscle pains. Bone pain: bone turnover is abnormally low and bone mineral density is typically increased. Abdominal pain. Paraesthesiae (tingling, vibrating, burning and numbness) of the face, fingers and toes. Facial twitching. Carpopedal spasm. Stridor. Convulsions (usually grand mal). Syncope. Emotional lability, anxiety and depression, confusion. Memory impairment. Lethargy. Headaches. Brittle nails. Dry hair and skin. Painful menstruation. […] Important points to elicit in the history include: History of previous neck surgery. Family history of any hypoparathyroid disorders. […] […] […] Complications of hypoparathyroidism The complications are mostly due to hypocalcaemia. The classical complications of hypoparathyroidism include chronic kidney disease, calcium-containing kidney stones, cataracts and basal ganglia calcification.

• #1 Hypoparathyroidism – Wikipedia

  https://en.wikipedia.org/wiki/Hypoparathyroidism

  Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH). […] The diagnosis is made with blood tests, and other investigations such as genetic testing depending on the results. […] Diagnosis is by measurement of calcium, serum albumin (for correction) and PTH in blood. If necessary, measuring cAMP (cyclic AMP) in the urine after an intravenous dose of PTH can help in the distinction between hypoparathyroidism and other causes. […] Differential diagnoses are: Pseudohypoparathyroidism (normal PTH levels but tissue insensitivity to the hormone, associated with intellectual disability and skeletal deformities) and pseudopseudohypoparathyroidism. […] Other tests include ECG for abnormal heart rhythms, and measurement of blood magnesium levels.

• #1 Hypoparathyroidism | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hypoparathyroidism?lang=us

  Hypoparathyroidism results from reduced secretion of parathyroid hormone by the parathyroid glands. It results in hypocalcemia. […] Hypoparathyroidism has an estimated prevalance 37 per 100,000 person-years and incidence of 0.8 per 100 000 person-years. It carries no increased risk of mortality. The majority of cases are due to complications from anterior neck surgery. […] There are a number of causes of hypoparathyroidism: iatrogenic, e.g. post parathyroidectomy or thyroidectomy; congenital absence of the parathyroid glands, which may be syndromic in thymic aplasia, or 22q11.2 deletion syndrome (a.k.a. DiGeorge syndrome); familial, e.g. autoimmune polyendocrine syndrome type 1; idiopathic (probably autoimmune-mediated destruction). […] Markers: parathyroid hormone (PTH) level: low; serum phosphate level: high; serum calcium level: low. […] Differential diagnosis: Pseudohypoparathyroidism; Pseudopseudohypoparathyroidism.

• #1 Hypoparathyroidism: Aetiology, diagnosis and challenges in management | ECE2019 | 21st European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0063/ea0063npd2.1

  Hypoparathyroidism is an endocrine disease resulting in hypocalcemia due to inappropriately low circulating parathyroid hormone levels. […] All healthcare personnel involved in the management of patients with chronic hypoparathyroidism should have knowledge about symptoms, treatment and potential complications. […] In adults, hypoparathyroidism most commonly is an acquired condition due to neck surgery or autoimmunity. […] In children, adolescents and young adults, underlying genetic conditions have to be considered. […] Acute symptoms of hypoparathyroidism are caused by decreasing and low circulating levels of calcium. […] In patients with chronic hypoparathyroidism, it is important to have basic knowledge about symptoms and treatment of hypercalcemia as overtreatment frequently occurs.

• #1 Hypoparathyroidism: Causes, diagnosis, management – McMaster Perspective – Interviews – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/interviews/perspective/336861,hypoparathyroidism-causes-diagnosis-management

  Inadequate parathyroid function is most commonly seen post surgery, post neck surgery. It could be post parathyroidectomy, post thyroidectomy. Any extensive neck surgery that will impair the blood supply of the parathyroid glands or damage the parathyroid tissue can result in postsurgical hypoparathyroidism and 75% of people who have hypoparathyroidism have it post surgery. […] The important point that I really wanted to emphasize to our colleagues is that we need to evaluate why a patient has hypoparathyroidism. First, we make the diagnosis. If the calcium corrected for albumin or the ionized calcium is low and the PTH is low or inappropriately in the low to mid-normal reference rangebecause the normal response in the presence of hypocalcemia is an elevation in PTHso, if the PTH is not elevated, then there’s a problem with inadequate parathyroid function.

• #1 Diagnosis and Treatment > Signs and Symptoms > Hypoparathyroidism

  https://edm.bioscientifica.com/cases/signs-symptoms_386?access_0=all&t=gland_10

  ADH1 is a rare cause of hypoparathyroidism due to activating CASR mutations and is the mirror image of familial hypocalciuric hypercalcaemia. […] This case highlights the importance of correctly identifying genetic causes of hypocalcaemia to allow for proper management and screening of family members.

• #1 Parathyroid Disorders | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0815/p249.html

  Hypoparathyroidism most commonly occurs after inadvertent damage or removal of parathyroid glands during neck surgery. […] Autoimmune parathyroid destruction, either isolated or as part of a multiple endocrine deficiency syndrome, is another important cause of hypoparathyroidism. […] Most patients with hypoparathyroidism present with hypocalcemia. […] It is important to ensure repletion to normal levels of vitamin D and magnesium in these patients. […] Serum levels of PTH, phosphorus, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D can help differentiate between disorders causing hypocalcemia. […] Long-term management of hypoparathyroidism should include at least initial involvement of an endocrinologist.

• #1 Autoimmune Hypoparathyroidism Symptoms: Diagnosis & Treatment | Maggie Yu MD, IFMCP

  https://drmaggieyu.com/blog/autoimmune-hypoparathyroidism-symptoms-diagnosis-treatment/

  Did you know that autoimmune hypoparathyroidism, a rare condition, affects roughly 1 in 100,000 people and causes dominant hypocalcemia in affected individuals? […] Understanding these symptoms is crucial for affected individuals in getting the right clinical treatment and improving your quality of life. […] Consult Healthcare Providers: Always consult with healthcare professionals for accurate diagnosis and personalized treatment plans tailored to your specific needs, including therapy for chronic hypoparathyroidism in individual cases. […] Understand Diagnostic Tests: Familiarize yourself with the diagnostic tests for autoimmune hypoparathyroidism, including blood tests and imaging, to better understand your condition. […] Blood tests are crucial for diagnosing autoimmune hypoparathyroidism. A PTH blood test measures parathyroid hormone levels. Low PTH levels indicate hypoparathyroidism. Calcium blood tests check calcium levels in the blood. Low calcium levels can confirm the diagnosis. […] Doctors use blood tests to check calcium and parathyroid hormone levels. They may also run antibody tests to see if your immune system is attacking your glands.

• #1 Hypoparathyroidism: Causes, diagnosis, management – McMaster Perspective – Interviews – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/interviews/perspective/336861,hypoparathyroidism-causes-diagnosis-management

  We do want everybody to think about these conditions. Is it autoimmune? Does our patient have adrenal insufficiency? Have they had mucocutaneous candidiasis? Do they have other features of genetic abnormalities such as a cleft palate, like DiGeorge syndrome? […] In one of the papersand there were about 18 papers that we published on hypo- and hyperparathyroidismwe carefully walk the practitioner through the evaluation of hypoparathyroidism. […] We presented in the survey paper what the experts do, but there are certainly areas of disagreement. How often should we be evaluating these patients? Which tests should be done at baseline? […] Its important to check PTH. Its also important to check magnesium and phosphate and do a 24-hour urine for calcium and creatinine. Those are important points and we also always want to get renal function, assessment of renal function.

• #1 Hypoparathyroidism: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22672-hypoparathyroidism

  Hypoparathyroidism is generally diagnosed when a person has low levels of calcium and parathyroid hormone in their blood. […] A person is considered to have chronic hypoparathyroidism if they have low blood levels of parathyroid hormone and calcium at least twice within six months. […] If you’re experiencing symptoms of hypoparathyroidism, your healthcare provider will perform a physical exam and ask questions about your symptoms and medical history. […] They may have you undergo one or more of the following tests, which can help diagnose hypoparathyroidism: Parathyroid hormone (PTH) blood test, Calcium blood test, Phosphorus blood test, Magnesium blood test, 24-hour urine test. […] Hypoparathyroidism is a rare condition. It affects fewer than 200,000 people in the United States. […] The goal of treatment for hypoparathyroidism is to minimize symptoms and correct the amount of calcium and minerals in your body.

• #1 Hypoparathyroidism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/132

  Laboratory testing should confirm low ionised or albumin-corrected total calcium and low or inappropriately normal intact plasma parathyroid hormone, while also verifying normal serum magnesium and 25-hydroxyvitamin D levels. […] If symptoms are present, replacement of calcium and/or magnesium should be promptly instituted with careful monitoring along with activated vitamin D metabolites for chronic treatment. […] Definitions of permanent post-surgical hypoparathyroidism vary. Persistently low intact PTH levels in the presence of hypocalcaemia requiring treatment for at least 6 months (some guidelines state at least 12 months) post-procedure generally indicates that the condition is permanent. […] Key diagnostic factors include history of thyroid, parathyroid, or laryngeal surgery, chronic alcoholism, malnutrition, malabsorption, diarrhoea, muscle twitches, spasms, cramps, paraesthesias, numbness, tingling, poor memory, slowed thinking, Chvostek’s sign, convulsions, irregular heart beat, tachycardia, and Trousseau’s sign.

• #1 Management of hypoparathyroidism: a Position Statement of the Expert Group of the Polish Society of Endocrinology | Misiorowski | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/96950/74920

  Hypoparathyroidism (HypoPT) is a rare disorder characterized by an insufficient production of parathyroid hormone (PTH), resulting in hypocalcemia and hyperphosphatemia. HypoPT may occur in the form of PTH resistance known as pseudohypoparathyroidism. […] The diagnosis of HypoPT requires confirmed hypocalcemia (low serum calcium adjusted for albumin or low ionized calcium) in the presence of undetectable or inappropriately low levels of intact PTH on at least 2 occasions at least 2 weeks apart. […] The diagnosis of HypoPT is confirmed by the finding of hypocalcemia (low serum calcium adjusted for albumin or low ionized calcium) in the presence of undetectable or inappropriately low intact PTH levels on at least 2 occasions separated by at least 2 weeks. […] HypoPT is further confirmed by additional abnormalities caused by PTH deficiency, although their presence is not required to establish the diagnosis. These abnormalities include elevated serum phosphate levels, reduced 1,25-dihydroxyvitamin D [1,25(OH)2D], and low urinary calcium excretion. Postsurgical HypoPT can be defined as permanent if it persists for 12 months or longer after neck surgery.

• #1 Managing hypoparathyroidism for GPs – Parathyroid UK

  https://parathyroiduk.org/medical-professionals/managing-hypoparathyroidism-for-gps/

  Hypoparathyroidism is a difficult condition to manage. Diagnosis is often only found by an incidental calcium blood test or seizure but patient may have felt ‘not quite right’ for years in some cases. […] All patients require careful, ongoing management and regular testing. […] Symptoms within the normal range. As the normal reference range for calcium was set up using healthy people, it does not always apply to those with hypopara. […] A patient may also be more symptomatic when Vitamin D levels are low despite apparently ‘normal ‘calcium levels. […] 24 hour urine test. Urinary calcium and urinary phosphate need regular monitoring. […] Calcium supplements are bad for the kidneys. […] No patient should feel that they are being left alone to deal with this difficult and frightening condition. […] It is therefore essential to provide a support service for those hypopara patients who need it, in the form of regular blood tests.

• #1 Parathyroid Disorders | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0300/p289.html

  Hypoparathyroidism is rare and usually caused by iatrogenic destruction of the parathyroid glands during anterior neck surgery (75% of cases). Other, less common etiologies include autoimmune, genetic, metabolic, and malignant causes. Hypoparathyroidism is due to inadequate PTH secretion or an activating mutation of the CASR gene, either of which results in renal calcium loss, decreased osteoclast activity, and decreased production of 1,25-dihydroxyvitamin D. This typically leads to signs and symptoms consistent with hypocalcemia. Hypoparathyroidism is diagnosed by a low or normal intact PTH level with concomitant low serum corrected calcium level and normal serum magnesium level. […] In chronic hypoparathyroidism, goals of treatment are preventing symptoms of hypocalcemia, maintaining serum calcium concentration at the low end of the normal range while also avoiding hypercalcemia, and limiting hypercalciuria. Oral calcium (1.5 to 3 g of elemental calcium per day) and vitamin D analogues, such as calcitriol (1,25-dihydroxycholecalciferol; Rocaltrol), are the mainstays of therapy. In the absence of adequate PTH, these supplements may lead to hypercalciuria and subsequent complications of nephrocalcinosis and nephrolithiasis. Thiazide diuretics can mitigate these effects by decreasing hypercalciuria. […] Hypoparathyroidism is diagnosed by a low or normal intact PTH level with concomitant low serum corrected calcium level and normal serum magnesium level.

• #1 Hypoparathyroidism: Aetiology, diagnosis and challenges in management | ECE2019 | 21st European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0063/ea0063npd2.1

  As primary treatment, activated vitamin D analogues (calcitriol and alfacalcidiol) plus calcium supplements in divided doses are recommended. […] Recently, a synthetic PTH-analogue has become commercially available. […] The lecture will focus on a patient orientated, team based approach in the management of chronic endocrine conditions as hypoparathyroidism.

• #1 SciELO Brazil – Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology

  https://www.scielo.br/j/aem/a/bZ5f5XXPqbDDBzw84kFVpGg/

  Hypoparathyroidism is suspected on clinical grounds, but its diagnosis is based on laboratory tests indicating inappropriately low PTH levels in the presence of hypocalcemia. […] The diagnosis of hypoparathyroidism is established in the presence of calcium levels below the normal range, but in hypoparathyroidism, the levels are usually below 7.5 mg/dL. […] The values of intact PTH are low or undetectable. In the presence of hypocalcemia, values below 20 ng/mL are diagnostic of hypoparathyroidism. […] Treatment of hypoparathyroidism is aimed at correcting hypocalcemia and hyperphosphatemia, reducing symptoms, and preventing chronic complications resulting from the disease or its treatment. […] The treatment goal is to maintain the patient asymptomatic with a total calcium level close to the lower limit of the normal range, with the administration of active vitamin D and calcium salts. […] The use of PTH and its derivatives has been tested with some success in the treatment of hypoparathyroidism, and the use of PTH (1-84) has been approved by American and European agencies (FDA and EMA).

• #1 Beyond hypocalcemia: the impact of permanent post-operative hypoparathyroidism on patient quality of life—a narrative review – Dhillon – Annals of Thyroid

  https://aot.amegroups.org/article/view/7135/html

  Hypocalcemia secondary to hypoparathyroidism is one of the most common post-operative complications following thyroidectomy. […] The management of hypocalcemia following thyroid surgery can be medically complex, challenging both the patient and the provider. […] According to the ATA Surgical Affairs Committee Statement published in 2017, the absolute value, trend and slope of calcium and PTH values after surgery, can be used to predict permanent hypoparathyroidism. […] Prediction of transient hypoparathyroidism that evolves into in a permanent state is not well established. […] The current guidelines for treatment of permanent hypoparathyroidism recommend targeting serum calcium within the low-normal range (less than or equal to 8.8 mg/dL), and serum phosphorus within the high-normal range (higher than or equal to 4.5 mg/dL).

• #1

  https://link.springer.com/article/10.1007/s12020-024-03807-2

  Hypoparathyroidism is defined by hypocalcemia with inappropriately normal or low parathyroid hormone levels. The current standard treatment consists of lifelong calcium and/or vitamin D supplementation. Even while on stable treatment regimens, hypoparathyroid patients might still suffer from symptoms that can negatively impact their quality of life. […] The majority of the included studies used a guideline-conform definition of hypoparathyroidism, and the SF-36 was the most often applied tool. Almost all studies (87%) reported statistically significantly lower scores in at least one quality of life domain compared to a norm population or controls. […] Patients with hypoparathyroidism receiving standard treatment report impairments in quality of life. The reasons for these impairments are probably multifaceted, making regular monitoring and the inclusion of various professionals necessary.

• #1 The Bumpy Road to Hypoparathyroidism Diagnosis and Treatment | DDx Podcast | Figure 1

  https://www.figure1.com/resources/ddx/seasons/season-10/the-bumpy-road-to-hypoparathyroidism-diagnosis-and-treatment/

  It’s a summer day and a 45-year-old is out for a drive. […] Fortunately, she makes it home safely, but it will take many wrong turns and the help of Dr. Google to determine a diagnosis of hypoparathyroidism, a rare bone disorder. […] Dr. Mannstadt: She had some occasional crampings in her hands, numbness around the face and her lips, and that was going on for several months. […] Dr. Mannstadt: A very low calcium was found which is typical for this disease and a low or undetectable level of parathyroid hormone, PTH, which is the cause of the disease causing hypocalcemia, low calcium levels. […] Dr. Mannstadt: I think that the rarity of the disease, the lack of a cause, and the symptoms that are somewhat nonspecific all contribute to some delay in diagnosis. […] Once our patient was diagnosed she began the standard treatment: an oral calcium and vitamin D supplement, calcitriol.

• #1 The Bumpy Road to Hypoparathyroidism Diagnosis and Treatment | DDx Podcast | Figure 1

  https://www.figure1.com/resources/ddx/seasons/season-10/the-bumpy-road-to-hypoparathyroidism-diagnosis-and-treatment/

  Dr. Mannstadt: The current standard of care, it does not replace the functions of parathyroid hormone. […] Dr. Mannstadt: The advantage of this treatment is that you get back the actions of parathyroid hormone that are on many different organs, bones, kidneys, and indirectly on the intestine. […] Our patient had to wait months before she was diagnosed with hypoparathyroidism. […] Dr. Mannstadt: Always listen to the patient and if a symptom that is unexplained doesn’t go away after a certain time, then we have to look broader, right, every physician knows that. […] Dr. Mannstadt: Treatment options that are not optimal, like the conventional treatment in hypoparathyroidism, it is much appreciated that patients, industry, and physicians make a concerted effort, actually, to develop new drugs and colleagues from all over the country are attentive to new trials and connect patients with the centers that conduct these clinical trials.

• #2 Hypoparathyroidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441899/

  Hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. […] Hypoparathyroidism treatment primarily consists of correcting calcium, vitamin D, and magnesium deficiencies with supplementation. […] Hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. Other findings that support this diagnosis include elevated serum phosphorus, decreased 1,25-dihydroxyvitamin D, and elevated urinary fractional calcium excretion levels. […] Once hypomagnesemia has been excluded, hypoparathyroidism is typically diagnosed with laboratory studies confirming a low corrected calcium level as well as a decreased or undetectable parathyroid hormone level. Other laboratory studies are also utilized to help exclude differential diagnoses and support a hypoparathyroidism diagnosis. […] A decreased corrected calcium in conjunction with a reduced or undetectable PTH level on 2 different serum tests at least 2 weeks apart confirms the diagnosis; therefore, these and some other supportive laboratory tests are recommended when assessing patients for PTH deficiency.

• #2

  https://www.healio.com/clinical-guidance/hypoparathyroidism/diagnostic-workup-presentation-and-diagnosis

  Hypoparathyroidism is diagnosed biochemically, with hypocalcemia and low or inappropriately normal parathyroid hormone (PTH) levels representing the hallmark features of the disease. A formal diagnosis of hypoparathyroidism (hypoPT) requires the concomitant occurrence of both of the following: […] two episodes of hypocalcemia at least 2 weeks apart; and […] an undetectable, low or inappropriately normal PTH level. […] The level of PTH is measured by automated immunoassay methods of different generations. […] For the diagnosis of hypoPT, only second- or third-generation assays should be used. […] In the context of hypocalcemia and a low or inappropriately normal PTH, additional biochemical abnormalities which support the diagnosis include the following: […] high-normal or elevated serum phosphate levels; […] low or low-normal circulating concentrations of active vitamin D (calcitriol); […] low or low-normal circulating concentrations of bone turnover markers; and […] elevated fractional excretion of calcium.

• #2 Hypoparathyroidism: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/122207-overview

  Hypoparathyroidism is a condition of parathyroid hormone (PTH) deficiency. Primary hypoparathyroidism, the subject of this article, is a state of inadequate PTH activity; this syndrome results from iatrogenic causes or one of many rare diseases. In the absence of adequate PTH activity, the ionized calcium concentration in the extracellular fluid falls below the reference range. […] Laboratory tests in the workup of hypoparathyroidism include parathyroid and hormone studies, with primary hypoparathyroidism being defined by a low concentration of PTH with a concomitant low calcium level. […] Measurement of 25-hydroxy vitamin D is important to exclude vitamin D deficiency as a cause of hypocalcemia; in this situation, PTH levels will be high. […] Serum magnesium is measured because hypomagnesemia may cause PTH deficiency and subsequent hypocalcemia. […] Serum phosphorus levels are tested because PTH is a phosphaturic hormone; in its absence, phosphorus levels in the blood rise.

• #2 Hypoparathyroidism: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000385.htm

  Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH). […] Your health care provider will do a physical exam and ask about symptoms. […] Tests that will be done include: PTH blood test, Calcium blood test, Magnesium, 24-hour urine calcium test. […] The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body. […] The outcome is likely to be good if the diagnosis is made early. […] Contact your provider if you develop any symptoms of hypoparathyroidism.

• #2 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Diagnosing hypoparathyroidism (investigations) The diagnosis of hypoparathyroidism requires confirmed hypocalcaemia in the presence of undetectable or inappropriately low levels of endogenous PTH and the absence of hypomagnesaemia. Hypomagnesaemia, along with iron or copper overload, are reversible causes of hypoparathyroidism. […] Blood tests (to exclude other causes of hypocalcaemia): Calcium, phosphate, PTH and alkaline phosphatase: Typical blood test results in hypoparathyroidism: Low serum calcium. High serum phosphate. Low PTH. Normal alkaline phosphatase. Typical blood test results in pseudohypoparathyroidism: Low serum calcium. High or normal PTH. […] UEs: to exclude chronic kidney disease. 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3: to exclude vitamin D deficiency as a cause of hypocalcaemia. 25-hydroxyvitamin D3 is normal in hypoparathyroidism and pseudohypoparathyroidism but 1,25-dihydroxyvitamin D3 is low because PTH is not available for its activation.

• #2 SciELO Brazil – Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology

  https://www.scielo.br/j/aem/a/bZ5f5XXPqbDDBzw84kFVpGg/

  Objective To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. […] An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil. […] The objective of this document is to answer routine questions and serve as a guideline for endocrinologists and clinicians in Brazil. […] The diagnosis of hypoparathyroidism should take into account the presence of suggestive clinical manifestations, history of surgery or cervical irradiation, and factors that might suggest the etiology of the disease, such as concomitant autoimmune conditions or syndromic manifestations. […] The laboratory evaluation must include serum measurement of total calcium corrected for albumin, PTH, phosphorus, magnesium, creatinine, and 25(OH)D, in addition to 24-hour urinary calcium.

• #2 Hypoparathyroidism Workup: Laboratory Studies

  https://emedicine.medscape.com/article/122207-workup

  Primary hypoparathyroidism is defined by a low concentration of PTH with a concomitant low calcium level. […] In secondary hypoparathyroidism, the serum PTH concentration is low and the serum calcium concentration is elevated. […] Measurement of 25-hydroxy vitamin D: This measurement is important to exclude vitamin D deficiency as a cause of hypocalcemia; in this situation PTH levels will be high. […] Serum magnesium: Hypomagnesemia may cause PTH deficiency and subsequent hypocalcemia. Exclude it in any patient with primary hypoparathyroidism. […] Serum phosphorus: PTH is a phosphaturic hormone. In its absence, phosphorus levels in the blood rise.

• #2 Diagnosis of hypopara – Parathyroid UK

  https://parathyroiduk.org/hypoparathyroidism/diagnosis-of-hypopara/

  Diagnosis of Hypoparathyroidism […] How is Hypoparathyroidism Diagnosed? […] Hypoparathyroidism is primarily diagnosed through a calcium blood test. Key findings include: Low blood calcium, High blood phosphate, Low parathyroid hormone (PTH) levels. […] A bone scan and kidney scan are typically requested during the initial appointment. […] A 24-hour urine test is often required. This test involves collecting urine over a 24-hour period, so it requires some planning. […] During an examination, your doctor may look for the following signs: Chvostek’s Sign: Tapping in front of the ear may cause facial twitching if calcium levels are low, Carpopedal Spasm: Inflating a blood pressure cuff may trigger painful muscle spasms in the hands and feet, Cataracts: Your eyes may be checked for cataracts, which can be a complication, Reflexes: Hyperactive reflexes may be present, detected by tapping tendons (e.g., knee or elbow) using a tendon hammer.

• #2 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Additional blood tests: If an autoimmune process is suspected, look for co-inciding thyroid and adrenal insufficiency: Thyroid-stimulating hormone (TSH), thyroxine and thyroid autoantibodies. Adrenocorticotrophic hormone (ACTH) and adrenal antibodies. […] Urine tests: 24-hour urinary calcium is usually low. Other possible investigations: ECG: prolonged QT interval which may progress to ventricular fibrillation or heart block. Echocardiogram: cardiac abnormalities (in DiGeorge’s syndrome). Renal ultrasound: looking for renal calculi. Hand radiography: looking for shortened metacarpals. Brain MRI scan: basal ganglia calcification (sign of a long-standing hypocalcaemic state). Genetic studies: as appropriate. […] […] […] Symptoms of hypoparathyroidism (presentation) This is essentially with the symptoms of hypocalcaemia. Hypocalcaemia typically presents as perioral numbness, paresthesia, neurocognitive deficits, weakness and carpopedal muscle spasms. Life-threatening complications, such as cardiac arrhythmias, laryngeal spasm, tetany and seizures, can also occur.

• #2 Diagnosing and Monitoring Patients with Hypoparathyroidism

  https://www.knowhypopara.com/identify-consequences/diagnosis-and-monitoring/

  DIAGNOSIS AND MONITORING […] Diagnosis and Monitoring Involve Symptomology as Well as Lab Values […] Serum calcium: levels below the lower limits of normal range confirmed on ≥ 2 measures help establish the diagnosis […] Serum PTH: low or inappropriately normal levels (ie, < 20 pg/mL) in the presence of hypocalcemia on ≥ 2 measures help establish the diagnosis [...] Serum phosphate: levels in the upper normal or obviously elevated range may be helpful in diagnosis and evaluation [...] 24-hour urinary calcium excretion: used along with estimated or calculated GFR and biochemical nephrolithiasis risk profile (if clinically warranted) [...] Patient-reported outcome measures [...] Medical and family history [...] Physical examination [...] Target-organ imaging [...] Genetic testing [...] Guidelines recommend performing target-organ imaging, such as a renal ultrasound and a CT scan, at diagnosis and regularly throughout the course of the disease.

• #2 Diagnosing HypoPT

  https://www.webmd.com/women/hypoparathyroidism-diagnosis-tests

  A health care professional will check your blood to determine your levels of calcium, PTH, phosphorus, magnesium, and albumin. […] A urine test will let the doctor know how much calcium the kidneys are releasing. […] This test is an X-ray that can see the strength of your bones and help determine your risk of fractures. […] This test can tell if you have an abnormal heart rhythm. […] Your doctor may order this test to see if you have calcium built up in your brain. […] A simple physical exam can give your doctor more insight to see if you have hypoparathyroidism. […] Your doctor may ask about your personal health history as well as past neck surgery or other endocrine disease.

• #2 Diagnosis of hypopara – Parathyroid UK

  https://parathyroiduk.org/hypoparathyroidism/diagnosis-of-hypopara/

  Genetic testing is available for inherited forms of hypoparathyroidism. Genetic counseling can help families understand the condition’s impact. […] Additional tests may be recommended to identify the cause of hypoparathyroidism, including: Hand X-rays: To detect shortened bones associated with pseudohypoparathyroidism, Echocardiogram: To identify heart abnormalities linked to DiGeorge syndrome, Genetic Studies: For suspected inherited causes, Autoimmune Tests: If an autoimmune cause is suspected, further blood tests may be done, including thyroid function tests.

• #2 Diagnosis of hypopara – Hypopara UK

  https://www.hypopara.org.uk/diagnosis-of-hypopara/

  Your doctor may suggest some other tests to look for the cause of your hypoparathyroidism, for example: Hand x-rays to look for the shortened bones seen in pseudohypoparathyroidism. […] Echocardiogram (an ultrasound scan of the heart) to look for heart abnormalities associated with DiGeorge syndrome. […] Genetic studies special blood tests can be performed if your doctor suspects that you have an inherited cause for your hypoparathyroidism. […] If your doctor suspects that your hypoparathyroidism is caused by an autoimmune process, they may suggest some other blood tests. For example, they may want to look at your thyroid gland to check that this is not also affected.

• #2 Hypoparathyroidism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/132

  1st investigations to order include serum calcium, plasma intact PTH, serum albumin, serum magnesium, serum 25-hydroxyvitamin D, serum phosphorus, serum creatinine, and ECG. […] Investigations to consider include 24-hour urine calcium, creatinine, 24-hour magnesium, creatinine, liver function tests, arterial blood gases (ABGs), serum free thyroxine, thyrotropin, morning cortisol and adrenocorticotrophin (ACTH) stimulation testing, full blood count, serum iron, transferrin, ferritin, serum copper, ophthalmological examination, audiology, renal imaging, autoantibodies to type 1 interferon or 21-hydroxylase, and gene sequencing.

• #2 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Hypocalcaemia may be an asymptomatic laboratory finding or a life-threatening metabolic disturbance. Symptoms include: Muscle pains. Bone pain: bone turnover is abnormally low and bone mineral density is typically increased. Abdominal pain. Paraesthesiae (tingling, vibrating, burning and numbness) of the face, fingers and toes. Facial twitching. Carpopedal spasm. Stridor. Convulsions (usually grand mal). Syncope. Emotional lability, anxiety and depression, confusion. Memory impairment. Lethargy. Headaches. Brittle nails. Dry hair and skin. Painful menstruation. […] Important points to elicit in the history include: History of previous neck surgery. Family history of any hypoparathyroid disorders. […] […] […] Complications of hypoparathyroidism The complications are mostly due to hypocalcaemia. The classical complications of hypoparathyroidism include chronic kidney disease, calcium-containing kidney stones, cataracts and basal ganglia calcification.

• #2 Diagnosis of hypopara – Hypopara UK

  https://www.hypopara.org.uk/diagnosis-of-hypopara/

  Hypoparathyroidism is usually diagnosed via a simple calcium blood test. In hypoparathyroidism, your blood calcium level is low, your blood phosphate level is high, and your parathyroid hormone level is low. […] Further blood tests may then be carried out to confirm this diagnosis such as: thyroid function, kidney function, liver, bone profile, vitamin D levels. […] A bone scan and a kidney scan should be requested at the first appointment. […] A 24 hour urine test should be ordered regularly. You will be given a container in which to collect your urine over a 24 hour period. This needs planning! […] There are a number of things that your doctor may look for if hypoparathyroidism is suspected: Your doctor may tap in front of your ear with your mouth slightly open. If your calcium levels are low because of hypoparathyroidism, this can cause repeated twitching of the muscles in your face. This is called Chvosteks sign.

• #2 Diagnosis of hypopara – Hypopara UK

  https://www.hypopara.org.uk/diagnosis-of-hypopara/

  Your doctor may also inflate a blood pressure cuff around the lower part of your arm. If your calcium levels are low because of hypoparathyroidism, this can lead to carpopedal spasm. This may be painful so don’t allow this check to be done unless really necessary. You are not a guinea pig! […] Your eyes may be checked for cataracts which can be a complication of hypoparathyroidism. […] Your muscle reflexes may be checked. This is a painless examination done by tapping the tendons of the muscles, for example, at the knee or the elbow. It is done using a special instrument called a tendon hammer. If your calcium levels are low due to hypoparathyroidism, these reflexes can be much more forceful than normal. […] Genetic conditions can’t be prevented but genetic testing is available in centres around the UK. Genetic counselling aims to help parents understand how the condition may affect their family and enable them to make informed decisions.

• #2 Hypoparathyroidism | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hypoparathyroidism?lang=us

  Hypoparathyroidism results from reduced secretion of parathyroid hormone by the parathyroid glands. It results in hypocalcemia. […] Hypoparathyroidism has an estimated prevalance 37 per 100,000 person-years and incidence of 0.8 per 100 000 person-years. It carries no increased risk of mortality. The majority of cases are due to complications from anterior neck surgery. […] There are a number of causes of hypoparathyroidism: iatrogenic, e.g. post parathyroidectomy or thyroidectomy; congenital absence of the parathyroid glands, which may be syndromic in thymic aplasia, or 22q11.2 deletion syndrome (a.k.a. DiGeorge syndrome); familial, e.g. autoimmune polyendocrine syndrome type 1; idiopathic (probably autoimmune-mediated destruction). […] Markers: parathyroid hormone (PTH) level: low; serum phosphate level: high; serum calcium level: low. […] Differential diagnosis: Pseudohypoparathyroidism; Pseudopseudohypoparathyroidism.

• #2 Hypoparathyroidism – Wikipedia

  https://en.wikipedia.org/wiki/Hypoparathyroidism

  Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH). […] The diagnosis is made with blood tests, and other investigations such as genetic testing depending on the results. […] Diagnosis is by measurement of calcium, serum albumin (for correction) and PTH in blood. If necessary, measuring cAMP (cyclic AMP) in the urine after an intravenous dose of PTH can help in the distinction between hypoparathyroidism and other causes. […] Differential diagnoses are: Pseudohypoparathyroidism (normal PTH levels but tissue insensitivity to the hormone, associated with intellectual disability and skeletal deformities) and pseudopseudohypoparathyroidism. […] Other tests include ECG for abnormal heart rhythms, and measurement of blood magnesium levels.

• #2 Parathyroid Disorders | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0300/p289.html

  Hypoparathyroidism is rare and usually caused by iatrogenic destruction of the parathyroid glands during anterior neck surgery (75% of cases). Other, less common etiologies include autoimmune, genetic, metabolic, and malignant causes. Hypoparathyroidism is due to inadequate PTH secretion or an activating mutation of the CASR gene, either of which results in renal calcium loss, decreased osteoclast activity, and decreased production of 1,25-dihydroxyvitamin D. This typically leads to signs and symptoms consistent with hypocalcemia. Hypoparathyroidism is diagnosed by a low or normal intact PTH level with concomitant low serum corrected calcium level and normal serum magnesium level. […] In chronic hypoparathyroidism, goals of treatment are preventing symptoms of hypocalcemia, maintaining serum calcium concentration at the low end of the normal range while also avoiding hypercalcemia, and limiting hypercalciuria. Oral calcium (1.5 to 3 g of elemental calcium per day) and vitamin D analogues, such as calcitriol (1,25-dihydroxycholecalciferol; Rocaltrol), are the mainstays of therapy. In the absence of adequate PTH, these supplements may lead to hypercalciuria and subsequent complications of nephrocalcinosis and nephrolithiasis. Thiazide diuretics can mitigate these effects by decreasing hypercalciuria. […] Hypoparathyroidism is diagnosed by a low or normal intact PTH level with concomitant low serum corrected calcium level and normal serum magnesium level.

• #2 Hypoparathyroidism: Causes, diagnosis, management – McMaster Perspective – Interviews – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/interviews/perspective/336861,hypoparathyroidism-causes-diagnosis-management

  Inadequate parathyroid function is most commonly seen post surgery, post neck surgery. It could be post parathyroidectomy, post thyroidectomy. Any extensive neck surgery that will impair the blood supply of the parathyroid glands or damage the parathyroid tissue can result in postsurgical hypoparathyroidism and 75% of people who have hypoparathyroidism have it post surgery. […] The important point that I really wanted to emphasize to our colleagues is that we need to evaluate why a patient has hypoparathyroidism. First, we make the diagnosis. If the calcium corrected for albumin or the ionized calcium is low and the PTH is low or inappropriately in the low to mid-normal reference rangebecause the normal response in the presence of hypocalcemia is an elevation in PTHso, if the PTH is not elevated, then there’s a problem with inadequate parathyroid function.

• #2 Parathyroid Disorders | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0815/p249.html

  Hypoparathyroidism most commonly occurs after inadvertent damage or removal of parathyroid glands during neck surgery. […] Autoimmune parathyroid destruction, either isolated or as part of a multiple endocrine deficiency syndrome, is another important cause of hypoparathyroidism. […] Most patients with hypoparathyroidism present with hypocalcemia. […] It is important to ensure repletion to normal levels of vitamin D and magnesium in these patients. […] Serum levels of PTH, phosphorus, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D can help differentiate between disorders causing hypocalcemia. […] Long-term management of hypoparathyroidism should include at least initial involvement of an endocrinologist.

• #2 Hypoparathyroidism: Causes, diagnosis, management – McMaster Perspective – Interviews – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/interviews/perspective/336861,hypoparathyroidism-causes-diagnosis-management

  We do want everybody to think about these conditions. Is it autoimmune? Does our patient have adrenal insufficiency? Have they had mucocutaneous candidiasis? Do they have other features of genetic abnormalities such as a cleft palate, like DiGeorge syndrome? […] In one of the papersand there were about 18 papers that we published on hypo- and hyperparathyroidismwe carefully walk the practitioner through the evaluation of hypoparathyroidism. […] We presented in the survey paper what the experts do, but there are certainly areas of disagreement. How often should we be evaluating these patients? Which tests should be done at baseline? […] Its important to check PTH. Its also important to check magnesium and phosphate and do a 24-hour urine for calcium and creatinine. Those are important points and we also always want to get renal function, assessment of renal function.

• #2 2025 ICD-10-CM Diagnosis Code E20.9: Hypoparathyroidism, unspecified

  https://www.icd10data.com/ICD10CM/Codes/E00-E89/E20-E35/E20-/E20.9

  E20.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. […] The 2025 edition of ICD-10-CM E20.9 became effective on October 1, 2024. […] A condition caused by a deficiency of parathyroid hormone (or pth). It is characterized by hypocalcemia and hyperphosphatemia. Hypocalcemia leads to tetany. The acquired form is due to removal or injuries to the parathyroid glands. The congenital form is due to mutations of genes, such as tbx1; (see digeorge syndrome); casr encoding calcium-sensing receptor; or pth encoding parathyroid hormone. […] A disorder characterized by a decrease in production of parathyroid hormone by the parathyroid glands. […] An endocrine disorder characterized by decreased production of parathyroid hormone by the parathyroid glands. It is usually caused by damage of the parathyroid glands during head and neck surgery. Signs and symptoms include muscle cramps, abdominal pain, dry skin, brittle nails, cataracts, tetany, and convulsions.

• #2 Management of hypoparathyroidism: a Position Statement of the Expert Group of the Polish Society of Endocrinology | Misiorowski | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/96950/74920

  Hypoparathyroidism (HypoPT) is a rare disorder characterized by an insufficient production of parathyroid hormone (PTH), resulting in hypocalcemia and hyperphosphatemia. HypoPT may occur in the form of PTH resistance known as pseudohypoparathyroidism. […] The diagnosis of HypoPT requires confirmed hypocalcemia (low serum calcium adjusted for albumin or low ionized calcium) in the presence of undetectable or inappropriately low levels of intact PTH on at least 2 occasions at least 2 weeks apart. […] The diagnosis of HypoPT is confirmed by the finding of hypocalcemia (low serum calcium adjusted for albumin or low ionized calcium) in the presence of undetectable or inappropriately low intact PTH levels on at least 2 occasions separated by at least 2 weeks. […] HypoPT is further confirmed by additional abnormalities caused by PTH deficiency, although their presence is not required to establish the diagnosis. These abnormalities include elevated serum phosphate levels, reduced 1,25-dihydroxyvitamin D [1,25(OH)2D], and low urinary calcium excretion. Postsurgical HypoPT can be defined as permanent if it persists for 12 months or longer after neck surgery.

• #2 Hypoparathyroidism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/132

  Laboratory testing should confirm low ionized or albumin-corrected total calcium and low or inappropriately normal intact plasma parathyroid hormone, while also verifying normal serum magnesium and 25-hydroxyvitamin D levels. […] If symptoms are present, replacement of calcium and/or magnesium should be promptly instituted with careful monitoring along with activated vitamin D metabolites for chronic treatment. […] Hypoparathyroidism is caused by relative or absolute deficiency of plasma parathyroid hormone (PTH) synthesis and secretion. […] This leads to low albumin-corrected serum total calcium and elevated serum phosphate. […] Signs and symptoms can involve the neuromuscular, psychiatric, cardiac, ocular, dermatologic, gastrointestinal, and renal/urologic systems. […] Patients can also be asymptomatic.

• #2 Managing hypoparathyroidism for GPs – Parathyroid UK

  https://parathyroiduk.org/medical-professionals/managing-hypoparathyroidism-for-gps/

  Hypoparathyroidism is a difficult condition to manage. Diagnosis is often only found by an incidental calcium blood test or seizure but patient may have felt ‘not quite right’ for years in some cases. […] All patients require careful, ongoing management and regular testing. […] Symptoms within the normal range. As the normal reference range for calcium was set up using healthy people, it does not always apply to those with hypopara. […] A patient may also be more symptomatic when Vitamin D levels are low despite apparently ‘normal ‘calcium levels. […] 24 hour urine test. Urinary calcium and urinary phosphate need regular monitoring. […] Calcium supplements are bad for the kidneys. […] No patient should feel that they are being left alone to deal with this difficult and frightening condition. […] It is therefore essential to provide a support service for those hypopara patients who need it, in the form of regular blood tests.

• #2 Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10118685/

  Hypoparathyroidism is suspected on clinical grounds, but its diagnosis is based on laboratory tests indicating inappropriately low PTH levels in the presence of hypocalcemia. […] The treatment of hypoparathyroidism is focused on correcting hypocalcemia and hyperphosphatemia, reducing symptoms, and preventing chronic complications. […] The treatment goal is to maintain the patient asymptomatic with a total calcium level close to the lower limit of the normal range, with the administration of active vitamin D and calcium salts. […] The chronic complications of hypoparathyroidism are related to the disease progression and its treatment and include renal, ocular, cardiovascular, bone, and neuropsychiatric manifestations. Monitoring these complications is recommended.

• #2 Hypoparathyroidism: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22672-hypoparathyroidism

  Treatment can include: Taking calcium carbonate and vitamin D supplements, Eating a high-calcium and low-phosphorous diet, Getting parathyroid hormone (PTH) injections. […] Hypoparathyroidism is a rare condition. The good news is that it’s treatable. Symptoms of hypoparathyroidism can be mild and undetectable, so it’s important to let your healthcare provider know if you have risk factors for hypoparathyroidism such as having a family history of parathyroid conditions or having had neck or thyroid surgery.

• #2 The PARADIGHM (physicians advancing disease knowledge in hypoparathyroidism) registry for patients with chronic hypoparathyroidism: study protocol and interim baseline patient characteristics | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-021-00888-2

  Evaluation of HRQoL in patients with hypoparathyroidism has proved challenging because of variability of symptoms and differing types of study designs. […] The recombinant human parathyroid hormone (1-84), rhPTH(1-84), is full-length PTH that is approved in the United States and Europe as adjunctive treatment for patients with chronic hypoparathyroidism. […] The protocol-defined primary objective of PARADIGHM is to characterize and describe the long-term safety and effectiveness of rhPTH(1-84) in patients with chronic hypoparathyroidism under conditions of routine clinical practice. […] The secondary objective is to characterize and describe the course of chronic hypoparathyroidism, including overall health status, patient-reported outcomes for symptoms of hypoparathyroidism, and healthcare resource utilization in patients treated or not treated with rhPTH(1-84) under conditions of routine clinical practice.

• #2 Hypoparathyroidism: Symptoms and Treatment | Doctor

  https://patient.info/doctor/hypoparathyroidism-pro

  Laryngospasm can cause stridor and airway obstruction. Neuromuscular irritability can lead to muscle cramps, tetany and seizures. Heart: QT interval changes can cause syncope, arrhythmias and death. Calcium can be deposited in the kidneys, causing calculi. Stunted growth, malformed teeth and mental impairment can develop if untreated in childhood. Over-treatment with vitamin D can cause hypercalcaemia and renal impairment. […] […] […] Treatment for hypoparathyroidism Acute treatment If severe hypocalcaemia symptoms are present, such as tetany, urgent IV calcium should be given. […] Dietary advice A diet rich in dairy products containing calcium and vitamin D is recommended. […] Medication Conventional therapy with calcium supplements and active vitamin D analogues is effective in improving serum calcium as well as in controlling the symptoms of hypocalcaemia. PTH replacement is of value in lowering the doses of calcium and active vitamin D analogues required and may be of value in lowering long-term complications of hypoparathyroidism.

• #2 Beyond hypocalcemia: the impact of permanent post-operative hypoparathyroidism on patient quality of life—a narrative review – Dhillon – Annals of Thyroid

  https://aot.amegroups.org/article/view/7135/html

  Long-term management of hypoparathyroidism has turned towards PTH replacement therapy. […] Although normalization of biochemical parameters in patients with hypoparathyroidism is an important goal for post-operative management, the medical community must also address the impact of permanent hypocalcemia on patient QOL.

• #2 The Bumpy Road to Hypoparathyroidism Diagnosis and Treatment | DDx Podcast | Figure 1

  https://www.figure1.com/resources/ddx/seasons/season-10/the-bumpy-road-to-hypoparathyroidism-diagnosis-and-treatment/

  It’s a summer day and a 45-year-old is out for a drive. […] Fortunately, she makes it home safely, but it will take many wrong turns and the help of Dr. Google to determine a diagnosis of hypoparathyroidism, a rare bone disorder. […] Dr. Mannstadt: She had some occasional crampings in her hands, numbness around the face and her lips, and that was going on for several months. […] Dr. Mannstadt: A very low calcium was found which is typical for this disease and a low or undetectable level of parathyroid hormone, PTH, which is the cause of the disease causing hypocalcemia, low calcium levels. […] Dr. Mannstadt: I think that the rarity of the disease, the lack of a cause, and the symptoms that are somewhat nonspecific all contribute to some delay in diagnosis. […] Once our patient was diagnosed she began the standard treatment: an oral calcium and vitamin D supplement, calcitriol.

• #2 The Bumpy Road to Hypoparathyroidism Diagnosis and Treatment | DDx Podcast | Figure 1

  https://www.figure1.com/resources/ddx/seasons/season-10/the-bumpy-road-to-hypoparathyroidism-diagnosis-and-treatment/

  Dr. Mannstadt: The current standard of care, it does not replace the functions of parathyroid hormone. […] Dr. Mannstadt: The advantage of this treatment is that you get back the actions of parathyroid hormone that are on many different organs, bones, kidneys, and indirectly on the intestine. […] Our patient had to wait months before she was diagnosed with hypoparathyroidism. […] Dr. Mannstadt: Always listen to the patient and if a symptom that is unexplained doesn’t go away after a certain time, then we have to look broader, right, every physician knows that. […] Dr. Mannstadt: Treatment options that are not optimal, like the conventional treatment in hypoparathyroidism, it is much appreciated that patients, industry, and physicians make a concerted effort, actually, to develop new drugs and colleagues from all over the country are attentive to new trials and connect patients with the centers that conduct these clinical trials.

• #2 Both Ends of the Spectrum: Diagnosing, Examining, and Treating Hypoparathyroidism and Hyperparathyroidism Patients – Endocrine News

  https://endocrinenews.endocrine.org/both-ends-of-the-spectrum-diagnosing-examining-and-treating-hypoparathyroidism-and-hyperparathyroidism-patients/

  And once that diagnosis of hypoparathyroidism is finally made, for now, these patients are treated with active vitamin D and calcium, but that treatment can increase the risk of long-term complications because it can further elevate phosphate, which can cause calcium and phosphate to deposit in the brain, behind the eyes, and in the kidneys, which can cause nephrocalcinosis, with the whole renal parenchymal calcifying. […] Khan says that during her CEU talk, she will provide an update on all the new advances in drug therapy for hypoparathyroidism. […] We want to improve patients wellbeing from day to day, and we can normalize calcium with calcium and active vitamin D, but were not helping the long-term complications with conventional therapy. […] And it wasnt just the patient who was returned to work as a nurse in the operating room who benefitted from these new treatments for hypoparathyroidism.

• #2 Both Ends of the Spectrum: Diagnosing, Examining, and Treating Hypoparathyroidism and Hyperparathyroidism Patients – Endocrine News

  https://endocrinenews.endocrine.org/both-ends-of-the-spectrum-diagnosing-examining-and-treating-hypoparathyroidism-and-hyperparathyroidism-patients/

  During the course of a Phase 3 trial investigating a potential drug to treat adults with hypoparathyroidism, Aliya Khan, MD, FRCP, FACP, FACE, professor of Clinical Medicine at McMaster University in Ontario, Canada, had a patient who was an operating room nurse who had a total thyroidectomy and developed hypoparathyroidism. […] Her talk, titled Diagnosis and Management of Hyperparathyroidism Hypoparathyroidism, as its name suggests, will look at complications of the parathyroid glands from both ends of the calcium spectrum how to evaluate and prevent the short-term and long-term complications of hypoparathyroidism, and how and when to use PTH replacement therapy. […] A detailed assessment will be very helpful in evaluating the underlying condition and making the correct diagnosis. […] We really want to emphasize: check calcium, correct for an albumin, check PTH. And if both of them are low, or the PTH is inappropriately in the normal range, then look for hypoparathyroidism, confirm the diagnosis, she says.

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