- Main symptoms
- How the treatment is done
- Possible causes of hypoparathyroidism
- Causes of primary hypoparathyroidism
- Causes of secondary hypoparathyroidism
- Causes of pseudohypoparathyroidism
Hypoparathyroidism refers to a set of diseases, or situations, that lead to a decrease in the action of the hormone PTH, also known as parathormone.
This hormone is produced by the parathyroid glands, which are 4 small glands located behind the thyroid and is an important hormone that, together with vitamin D, maintains adequate calcium levels in the blood.
Thus, when there is a lack of PTH in the body, it is common to observe a decrease in blood calcium levels, known as hypocalcemia, which can cause signs such as weakness, muscle spasms, changes in bones, neurological problems or even heart problems. Learn more about hypocalcemia and what it can cause.
Main symptoms
The symptoms of hypoparathyroidism are mainly related to the problems that the inactivity of PTH causes. Thus, some signs and symptoms that may arise include:
- Strong muscle cramps; Muscle spasms; Muscle weakness or pain; Generalized seizures; Heart palpitations
Because PTH is the calcium-regulating hormone, when there is not enough PTH, calcium cannot be absorbed properly in the intestine and is still eliminated in the urine, leading to low blood calcium levels or hypocalcemia.
The intensity of the symptoms depends on the severity and speed of the loss of calcium levels. Many patients with hypoparathyroidism are asymptomatic, and only have symptoms when there is a need for more calcium in the body, such as during pregnancy, breastfeeding or with the use of drugs that reduce calcium.
In more chronic and mild cases, there may also be no symptoms, and the disease is only detected in routine tests, or there may be mild symptoms such as tingling and lack of sensation in the feet, hands or around the mouth.
How the treatment is done
The treatment of hypoparathyroidism has the main objective of controlling the decrease in calcium in the body, and should be guided by the endocrinologist according to its cause, severity, symptoms and blood calcium levels.
When calcium levels are very low, below 7.5 mg / dl, severe hypocalcemia appears and, in these cases, treatment in the hospital is necessary, with calcium replacement directly in the vein, with calcium gluconate.
When hypocalcemia is mild and chronic, treatment consists of replacing calcium and vitamin D orally. Magnesium helps to stimulate the production of PTH and, therefore, can be useful, especially when its levels are also low. Other remedies, such as thiazide diuretics or recombinant PTH replacement can be advised by the endocrinologist, depending on each case.
Possible causes of hypoparathyroidism
Hypoparathyroidism can be divided into 2 main types, depending on the causes that lead to the inaction of PTH:
- Primary hypoparathyroidism: occurs when PTH production is impaired because the glands have a problem or have been removed. Secondary hypoparathyroidism: it is when some other stimulus, such as low magnesium, causes the glands to produce less PTH without having a problem in them.
There is also a third case, which is called pseudo-hypoparathyroidism, which occurs in inherited diseases, that is, which pass through the family's genes, from parents to children, and which increase resistance in the organs where the hormone should act. Thus, the hormone is unable to perform its function even though it is being produced in sufficient quantity by the parathyroid glands.
Causes of primary hypoparathyroidism
This type occurs most of the time due to the removal of parathyroid glands, in cases of treatment of hyperparathyroidism, for example, but it can also occur due to accidental injury to parathyroid glands. This case happens when surgery is done on the neck region, namely the thyroid, for cancer or nodules. As the structures are very close and the glands are very small, it is sometimes difficult to identify and separate them from the other structures. Check when thyroid removal is necessary and how recovery is.
Causes of secondary hypoparathyroidism
This type of hypoparathyroidism is usually triggered by a persistent magnesium deficiency.
Although a slight low magnesium can stimulate the production of PTH, when the magnesium is very low, and for a long time, it sends a message to the parathyroid to not produce more PTH and still makes the organs insensitive to the hormone, so that it does not can act, causing hypoparathyroidism.
Causes of pseudohypoparathyroidism
Pseudohypoparathyroidism refers to a set of diseases in which genetic mutations, usually hereditary, make the body's tissues insensitive to the action of PTH. There are 3 types of pseudohypoparathyroidism, depending on whether they are related to a rare disease called Albright's hereditary osteoarthritis and the type of PTH resistance that is caused.
In response to the lack of action of PTH, the glands increase in size and try to produce more PTH, with normal or even high PTH levels in the blood, but this PTH is unable to act. Therefore, the clinical picture is the same as that of hypoparathyroidism, as it is as if the hormone did not exist. Therefore, it cannot be called typical hypoparathyroidism, since in reality the circulating PTH levels are normal or even increased, being then called pseudo-hypoparathyroidism, which means “similar to hypoparathyroidism”.
