Medicines for Hypoparathyroidism

What it is

Hypoparathyroidism is a condition in which the parathyroid glands — four tiny glands in the neck, near the thyroid — produce too little parathyroid hormone (PTH). This hormone is a key regulator of calcium in the blood, so when there is too little of it, the calcium level falls (hypocalcaemia) and the phosphate level tends to rise. The low calcium causes the symptoms, which can include tingling and numbness (particularly around the mouth and in the hands and feet), muscle cramps, twitching and spasms, and, if severe, more serious effects. The most common cause is damage to or accidental removal of the parathyroid glands during neck surgery (such as thyroid surgery); other causes include autoimmune conditions (where the immune system affects the glands), and, less commonly, genetic conditions and others. It can be temporary (for example after surgery, sometimes recovering) or permanent. Because the underlying problem is a lack of the hormone that controls calcium, hypoparathyroidism is managed by keeping the calcium level in a safe range, usually long-term.

How it is treated

Management aims to relieve symptoms and keep the blood calcium (and related levels) in a target range, usually long-term, while avoiding complications. Because the missing parathyroid hormone normally helps the body absorb and retain calcium, treatment is usually with calcium supplements together with active vitamin D preparations (which help the body absorb calcium), adjusted to maintain a stable calcium level — typically in the lower part of the normal range to avoid problems. Regular blood tests are important to monitor calcium and other levels and to guide the doses, as both too-low and too-high calcium can cause problems. Any acute, severe low-calcium episode is treated promptly, sometimes with calcium given into a vein in hospital. Where the condition is temporary (for example after surgery), treatment may be reduced as the glands recover. For long-term hypoparathyroidism, ongoing treatment and monitoring, and sometimes specialist endocrinology input, keep the condition well controlled; in selected cases, replacement parathyroid hormone treatment is used. The reassuring message is that hypoparathyroidism is manageable — keeping calcium stable with calcium and vitamin D preparations and regular monitoring controls the symptoms and protects health.