Hypoparathyroidism explained: symptoms and care

What hypoparathyroidism is

The parathyroid glands are four tiny glands in the neck, near the thyroid, whose job is to keep the level of calcium in the blood within a narrow, healthy range. They do this by producing parathyroid hormone, which raises calcium when it starts to fall. In hypoparathyroidism, the glands do not make enough of this hormone, so the body loses one of its main ways of keeping calcium up, and the blood calcium level drops too low. A low calcium level matters because calcium is needed for nerves and muscles to work properly, including the heart, so when it falls the nerves and muscles become over-excitable. Hypoparathyroidism is usually a long-term condition that needs ongoing management to keep calcium in a safe range, though with the right treatment and monitoring most people can control it well.

The symptoms it causes

The symptoms of hypoparathyroidism come mainly from the low blood calcium level and reflect nerves and muscles becoming over-excitable. Common early symptoms include tingling or pins and needles around the mouth, and in the fingers and toes, along with muscle cramps and twitching. If calcium falls further, the muscles can go into painful spasms, and the hands and feet may draw into stiff, cramped positions. Some people feel anxious, tired, low in mood, or have difficulty concentrating, sometimes described as brain fog. In more severe cases, low calcium can cause spasm of the throat, difficulty breathing, fits or disturbances of the heart's rhythm, which is why very low calcium is a medical emergency. Symptoms can be mild and grumbling or more troublesome, and they tend to improve once the calcium level is brought back up and kept steady.

What causes it

By far the most common cause of hypoparathyroidism is accidental injury to or removal of the parathyroid glands during surgery on the neck, such as thyroid surgery, because these tiny glands sit very close to the thyroid and can be bruised or removed. This can be temporary, recovering over weeks, or permanent. Less commonly, hypoparathyroidism can result from the immune system attacking the glands, from certain inherited conditions present from birth or running in families, or from a low level of another mineral, magnesium, which the glands need to work. Occasionally the cause is not clear. Because neck surgery is the leading cause, calcium is carefully monitored after such operations, and people are told which symptoms to watch for. Identifying the cause helps guide how the condition is managed and whether it is likely to be temporary or lifelong.

How it is managed

The aim of treatment in hypoparathyroidism is to keep the blood calcium at a safe, steady level and to relieve symptoms, and this is usually achieved with calcium and a form of vitamin D that helps the body absorb and use it, taken regularly and adjusted under specialist guidance. Because both too little and too much calcium cause problems, the level is monitored with blood tests, and doses are tailored to each person; kidney function and other minerals are also checked over time. For some people whose condition is difficult to control, replacing the missing parathyroid hormone itself may be considered by specialists. It is important to take treatment consistently and not to stop suddenly, and to attend monitoring appointments. If magnesium is low, correcting it can help the glands work. Care is generally overseen by a hormone specialist, particularly for long-term or complex cases.

Living with hypoparathyroidism

Living well with hypoparathyroidism centres on keeping calcium steady and staying alert to changes. Taking calcium and vitamin D treatment exactly as prescribed, at the right times, and not stopping it without advice, is the foundation, along with attending regular blood tests so doses can be fine-tuned. It helps to recognise the symptoms of calcium going too low — tingling around the mouth and fingertips, cramps and twitching — and too high, such as increased thirst, passing lots of urine, tummy upset or feeling unusually tired, so you can seek advice promptly. Severe symptoms such as fits, throat spasm, difficulty breathing or an irregular heartbeat are a 999 emergency. Carrying information about your condition, telling healthcare staff about it before procedures, and keeping in touch with your specialist team all support safe, steady control. With good management, most people lead full and active lives.