Highlights & Basics
- Hypoparathyroidism has a wide variety of presentations: from the asymptomatic patient with dramatically low serum calcium to the acutely symptomatic patient with neuromuscular irritability, tetany, painful muscle cramps, stridor, and even seizures with low serum calcium in the emergency department or recovery room.
- Majority of cases are post-surgery for benign and malignant thyroid disorders, hyperparathyroidism, and laryngeal or other head and neck cancers.
- Nonsurgical etiologies include: rare genetic conditions and syndromes; autoimmune destruction of the glands; destruction or invasion due to tumor, radiation, or infiltration by iron or copper; hypomagnesemia and magnesium depletion; and idiopathic.
- 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.
Quick Reference
History & Exam
Key Factors
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Definition
Epidemiology
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Citations
Khan AA, Bilezikian JP, Brandi ML, et al. Evaluation and management of hypoparathyroidism summary statement and guidelines from the Second International Workshop. J Bone Miner Res. 2022 Dec;37(12):2568-85.[Abstract][Full Text]
Mannstadt M, Cianferotti L, Gafni RI, et al. Hypoparathyroidism: genetics and diagnosis. J Bone Miner Res. 2022 Dec;37(12):2615-29.[Abstract][Full Text]
Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018 Jul;28(7):830-41.[Abstract][Full Text]
Gafni RI, Collins MT. Hypoparathyroidism. N Engl J Med. 2019 May 2;380(18):1738-47.[Abstract]
1. Khan AA, Bilezikian JP, Brandi ML, et al. Evaluation and management of hypoparathyroidism summary statement and guidelines from the Second International Workshop. J Bone Miner Res. 2022 Dec;37(12):2568-85.[Abstract][Full Text]
2. Patel KN, Yip L, Lubitz CC, et al. The American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg. 2020 Mar;271(3):e21-93.[Abstract]
3. Powers J, Joy K, Ruscio A, et al. Prevalence and incidence of hypoparathyroidism in the United States using a large claims database. J Bone Miner Res. 2013 Dec;28(12):2570-6.[Abstract][Full Text]
4. Hauch A, Al-Qurayshi Z, Randolph G, et al. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014 Nov;21(12):3844-52.[Abstract]
5. Bjornsdottir S, Ing S, Mitchell DM, et al. Epidemiology and financial burden of adult chronic hypoparathyroidism. J Bone Miner Res. 2022 Dec;37(12):2602-14.[Abstract][Full Text]
6. Underbjerg L, Sikjaer T, Mosekilde L, et al. The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res. 2015 Sep;30(9):1738-44.[Abstract][Full Text]
7. Mannstadt M, Cianferotti L, Gafni RI, et al. Hypoparathyroidism: genetics and diagnosis. J Bone Miner Res. 2022 Dec;37(12):2615-29.[Abstract][Full Text]
8. McDonald-McGinn DM, Sullivan KE. Chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). Medicine (Baltimore). 2011 Jan;90(1):1-18.[Abstract]
9. Hacıhamdioğlu B, Hacıhamdioğlu D, Delil K. 22q11 deletion syndrome: current perspective. Appl Clin Genet. 2015 May 18;8:123-32.[Abstract][Full Text]
10. Nesbit MA, Hannan FM, Howles SA, et al. Mutations affecting G-protein subunit alpha11 in hypercalcemia and hypocalcemia. N Engl J Med. 2013 Jun 27;368(26):2476-86.[Abstract][Full Text]
11. Hannan FM, Thakker RV. Calcium-sensing receptor (CaSR) mutations and disorders of calcium, electrolyte and water metabolism. Best Pract Res Clin Endocrinol Metab. 2013 Jun;27(3):359-71.[Abstract]
12. Betterle C, Garelli S, Presotto F. Diagnosis and classification of autoimmune parathyroid disease. Autoimmun Rev. 2014 Apr-May;13(4-5):417-22.[Abstract]
13. Unger S, Górna MW, Le Béchec A, et al. FAM111A mutations result in hypoparathyroidism and impaired skeletal development. Am J Hum Genet. 2013 Jun 6;92(6):990-5.[Abstract][Full Text]
14. William JH, Danziger J. Proton-pump inhibitor-induced hypomagnesemia: current research and proposed mechanisms. World J Nephrol. 2016 Mar 6;5(2):152-7.[Abstract][Full Text]
15. Viering DH, de Baaij JH, Walsh SB, et al. Genetic causes of hypomagnesemia, a clinical overview. Pediatr Nephrol. 2017 Jul;32(7):1123-35.[Abstract]
16. Wolf MT. Inherited and acquired disorders of magnesium homeostasis. Curr Opin Pediatr. 2017 Apr;29(2):187-98.[Abstract][Full Text]
17. Agus ZS. Mechanisms and causes of hypomagnesemia. Curr Opin Nephrol Hypertens. 2016 Jul;25(4):301-7.[Abstract]
18. Lo JC, Loh KC, Rubin AL, et al. Riedel's thyroiditis presenting with hypothyroidism and hypoparathyroidism: dramatic response to glucocorticoid and thyroxine therapy. Clin Endocrinol (Oxf). 1998 Jun;48(6):815-8.[Abstract]
19. Fatourechi MM, Hay ID, McIver B, et al. Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008. Thyroid. 2011 Jul;21(7):765-72.[Abstract]
20. Pasieka JL, Wentworth K, Yeo CT, et al. Etiology and pathophysiology of hypoparathyroidism: a narrative review. J Bone Miner Res. 2022 Dec;37(12):2586-601.[Abstract][Full Text]
21. Bergenfelz A, Nordenström E, Almquist M. Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy. Surgery. 2020 Jan;167(1):124-28.[Abstract]
22. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-68.[Abstract][Full Text]
23. Hopkins B, Steward D. Outpatient thyroid surgery and the advances making it possible. Curr Opin Otolaryngol Head Neck Surg. 2009 Apr;17(2):95-9.[Abstract]
24. Edafe O, Mech CE, Balasubramanian SP. Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism. Cochrane Database Syst Rev. 2019 May 22;(5):CD012845.[Abstract][Full Text]
25. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid. 2018 Jul;28(7):830-41.[Abstract][Full Text]
26. Solórzano CC, Thomas G, Berber E, et al. Current state of intraoperative use of near infrared fluorescence for parathyroid identification and preservation. Surgery. 2021 Apr;169(4):868-78.[Abstract][Full Text]
27. Gafni RI, Collins MT. Hypoparathyroidism. N Engl J Med. 2019 May 2;380(18):1738-47.[Abstract]
28. Dickerson RN, Alexander KH, Minard G, et al. Accuracy of methods to estimate ionized and "corrected" serum calcium concentrations in critically ill multiple trauma patients receiving specialized nutrition support. JPEN J Parenter Enteral Nutr. 2004 May-Jun;28(3):133-41.[Abstract]
29. Smit MA, van Kinschot CMJ, van der Linden J, et al. Clinical guidelines and PTH measurement: does assay generation matter? Endocr Rev. 2019 Dec 1;40(6):1468-80.[Abstract][Full Text]
30. Khan AA, Koch CA, Van Uum S, et al. Standards of care for hypoparathyroidism in adults: a Canadian and International Consensus. Eur J Endocrinol. 2019 Mar;180(3):P1-22.[Abstract][Full Text]
31. Chang WT, Radin B, McCurdy MT. Calcium, magnesium, and phosphate abnormalities in the emergency department. Emerg Med Clin North Am. 2014 May;32(2):349-66.[Abstract]
32. Bilezikian JP, Brandi ML, Cusano NE, et al. Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab. 2016 Jun;101(6):2313-24.[Abstract][Full Text]
33. Mannstadt M, Clarke BL, Vokes T, et al. Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol. 2013 Dec;1(4):275-83.[Abstract]
34. Watts NB, Bilezikian JP, Bone HG, et al. Long-term safety and efficacy of recombinant human parathyroid hormone (1-84) in adults with chronic hypoparathyroidism. J Endocr Soc. 2023 Mar 6;7(5):bvad043.[Abstract][Full Text]
35. Mannstadt M, Clarke BL, Bilezikian JP, et al. Safety and efficacy of 5 years of treatment with recombinant human parathyroid hormone in adults with hypoparathyroidism. J Clin Endocrinol Metab. 2019 Nov 1;104(11):5136-47.[Abstract][Full Text]
36. Tay YD, Tabacco G, Cusano NE, et al. Therapy of hypoparathyroidism with rhPTH(1-84): a prospective, 8-year investigation of efficacy and safety. J Clin Endocrinol Metab. 2019 Nov 1;104(11):5601-10.[Abstract][Full Text]
37. Khan AA, Rubin MR, Schwarz P, et al. Efficacy and safety of parathyroid hormone replacement with TransCon PTH in hypoparathyroidism: 26-week results from the phase 3 PaTHway trial. J Bone Miner Res. 2023 Jan;38(1):14-25.[Abstract][Full Text]
38. Winer KK, Yanovski JA, Sarani B, et al. A randomized, cross-over trial of once-daily versus twice-daily parathyroid hormone 1-34 in treatment of hypoparathyroidism. J Clin Endocrinol Metab. 1998 Oct;83(10):3480-6.[Abstract][Full Text]
39. Marcucci G, Masi L, Cianferotti L, et al. Chronic hypoparathyroidism and treatment with teriparatide. Endocrine. 2021 Apr;72(1):249-59.[Abstract][Full Text]
40. Ish-Shalom S, Caraco Y, Khazen NS, et al. Safety and efficacy of oral human parathyroid hormone (1-34) in hypoparathyroidism: an open-label study. J Bone Miner Res. 2021 Jun;36(6):1060-8.[Abstract][Full Text]
41. Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-2314.[Abstract][Full Text]
