Updated: 3/16/2021

Hypoparathyroidism

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Snapshot
  • A 35-year-old man presents to his surgeon for 1-week follow-up of his thyroidectomy for thyroid neoplasm. He reports that his post-operative recovery is going well and denies any symptoms except some muscle cramping. His past medical history includes hypertension. On physical exam, there are spasms of his triceps with blood pressure cuff inflation and facial muscle contractions with tapping of the cheeks.
Introduction
  • Clinical definition
    • acquired or genetic condition of ↓ parathyroid hormone (PTH) characterized by
      • ↓ calcium
      • normal or ↑ phosphate
  • Etiology
    • surgical excision or injury (most common)
    • autoimmune destruction
  • Pathogenesis
    • actions of PTH
      • ↑ bone resorption of calcium and phosphate
      • ↑ kidney reabsorption of calcium
      • ↓ kidney reabsorption of phosphate
      • ↑ kidney calcitriol production
      • causes ↑ serum calcium and ↓ serum phosphate
    • deficiency of PTH causes
      • ↓ serum calcium
      • ↑ serum phosphate
Presentation
  • Symptoms
    • symptoms of hypocalcemia
      • tetany
      • Chvostek sign
        • contraction of facial muscles with percussion of the facial nerve
        • Contraction of Cheek = Chvostek
      • Trousseau sign
        • carpal spasm with occlusion of brachial artery with a blood pressure
        • Tricep spasm = Trousseau sign
Studies
  • Diagnostic testing
    • studies
      • ↓ calcium
        • remember to correct with albumin
      • ↑ phosphate
      • ↓ or undetectable PTH level
    • ECG
      • prolonged QT interval 
  • Diagnostic criteria
    • ↓ serum calcium on 2+ occasions separated by 2+ weeks
    • ↓ or undetectable PTH level
Differential
  • Pseudohypoparathyroidism
    • distinguishing factors
      • same symptoms of hypocalcemia and hyperphosphatemia
      • ↑ serum PTH
Treatment
  • First-line
    • intravenous calcium gluconate
      • indication
        • symptomatic hypocalcemia
        • asymptomatic hypocalcemia < 7.6 mg/dL
    • oral calcium carbonate
      • indication
        • asymptomatic hypocalcemia >7.6 mg/dL
    • oral calcitriol
      • indication
        • asymptomatic hypocalcemia >7.6 mg/dL

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