The medical term hypoparathyroidism refers to a disease caused by hypothyroidism of the parathyroid glands, which leads to calcium deficiency due to insufficient secretion of the so-called parathyroid hormone. In most cases caused by a surgical intervention on the thyroid gland, parathyroid hypofunction is manifested by symptoms such as: Hair loss, brittle skin, muscle spasms, dementia or the formation of cataracts.
What is hypoparathyroidism?
Hypoparathyroidism is defined by a parathyroid hormone deficiency. The parathyroid glands, which usually consist of four small bodies, are located directly on the thyroid gland under the larynx and produce parathyroid hormone. This messenger substance, which in the case of hypoparathyroidism is present only in small quantities or not at all, ensures on the one hand an increase in the amount of calcium in the blood and on the other hand lowers its phosphate concentration. The parathyroid hormone deficiency caused by parathyroid hypofunction carries with it various negative effects, with which hypoparathyroidism can worsen and endanger both the physical and psychological condition of those affected.
Causes
Among the most common causes of hypoparathyroidism are surgical procedures on the thyroid gland, in which the parathyroid glands have been removed either by mistake or intentionally (due to radical thyroidectomy). Because the parathyroid glands are immediately adjacent to the thyroid gland, unintentional removal of the intact parathyroid glands (or portions thereof) is relatively common. The blood supply to the parathyroid glands can also be disturbed during the surgical procedure, thus impairing the blood supply and, in the worst case, causing them to die, resulting in hypoparathyroidism. However, excessive intake of vitamin D over a long period of time also inhibits the production of parathyroid hormone in the parathyroid glands and thus leads to hypoparathyroidism in the long term. Furthermore, radiation performed in the neck region (for example, in the case of a malignant tumor) or a long-term deficiency of magnesium as well as the so-called DiGeorge syndrome (caused by defective parathyroid glands) are among the triggers of hypoparathyroidism.
Symptoms, complaints, and signs
The symptoms of hypoparathyroidism are easy to recognize. Because of the calcium deficiency present, conduction between nerves and muscles is impaired, resulting in painful muscle spasms (cramps). These are called tetanic seizures. At first, sensations such as tingling, prickling, painful burning, numbness, or furriness occur in the forearms, hands, or mouth region. As the disease progresses, muscle spasms occur with a pawing of the hands typical of hypoparathyroidism and, less commonly, a pointed foot position. Cramping of the facial muscles results in a characteristic fish mouth position. If other muscles are affected by the tetanic seizures, further symptoms may occur. For example, shortness of breath may occur if the respiratory muscles are affected. If the muscles of the internal organs, such as the urinary bladder or intestines, spasm, this can cause abdominal pain, diarrhea and increased urination. There may also be anxiety, irritability, restlessness or depressed moods. In rare cases, sufferers also experience epileptic seizures. If hypothyroidism is not adequately treated in childhood, late effects such as changes in hair, skin and fingernails, cataracts, hair loss, dental abnormalities, motor disorders, calcification of the brain, inner ear, kidneys or heart muscle, as well as growth and developmental disorders and even mild mental retardation may occur.
Diagnosis and course
Hypoparathyroidism is diagnosed on the basis of presenting symptoms and determination of calcium levels, as well as by examination of the muscles and nerves. The calcium deficiency caused by hypoparathyroidism causes various physical symptoms. Muscle cramps and sensory disturbances (tetanic syndrome) occur, which can lead to a so-called tetanic seizure.Typical signs of such life-threatening seizures caused by hypoparathyroidism are tingling sensations in the hands and mouth, as well as urinary urgency, abdominal pain and diarrhea, followed by severe spasms of the muscles, which are manifested by an involuntarily contracted mouth (fish mouth), cramped hands and feet (paw position and pointed foot), with the affected persons usually being fully conscious. The cramping of the larynx, which sometimes also occurs, can lead to life-threatening respiratory distress, especially in children suffering from hypoparathyroidism. The phosphate excess is also manifested by easy excitability of muscles and nerves, as well as itching and reddened eyes. In addition, calcium deficiency and phosphate excess in untreated parathyroid hypofunction lead to a wide variety of symptoms such as hair loss, brittle skin, calcification of the eye lenses (cataracts) and brain (dementia), and the excess water also present in hypoparathyroidism can suddenly worsen vision.
Complications
Hypoparathyroidism causes various symptoms and complaints, which usually depend on the severity of the disease. However, in most cases, patients suffer from brittle skin and hair loss. Furthermore, dementia and disturbances of concentration and coordination occur. The affected person suffers from cataracts and severe pain in the muscles. The daily life of the affected person is limited by the hypoparathyroidism. Furthermore, sensory disturbances in various regions of the body may also occur. In the worst case, even paralysis and movement restrictions occur. The eyes are often red and itchy and the patient suffers from shortness of breath. Due to the shortness of breath, loss of consciousness or damage to the organs may occur in the further course. Treatment of hypoparathyroidism usually proceeds without complications. It quickly leads to a positive course of the disease and the symptoms disappear. Complications usually occur only when treatment starts too late and damage to organs has already occurred. In most cases, life expectancy is not affected by this disease.
When should you see a doctor?
If muscle cramps, numbness, and other typical symptoms are noticed, a doctor should be seen in the next few days. Other warning signs that need to be clarified quickly include abdominal pain, diarrhea, and tingling sensations in the hands and mouth, often accompanied by severe cramps that are manifested by cramped hands, feet, and mouth. Sufferers usually experience severe pain and shortness of breath – symptoms that need to be clarified immediately. Hypoparathyroidism is a life-threatening disease that can lead to dementia and various other complications as it progresses. Affected persons should go to their family doctor with the above-mentioned signs and, if necessary, visit a specialist clinic. If the disease is treated at an early stage, it usually progresses positively and the symptoms quickly subside. People who suffer from parathyroid disease or who have taken in too much vitamin D over a long period of time are particularly susceptible to developing hypoparathyroidism. Anyone who considers themselves to be in these risk groups must seek medical advice in any case.
Treatment and therapy
If the parathyroid glands have been accidentally removed, causing hypoparathyroidism, they can be made to grow again by grafting them into the patient’s muscle tissue (usually in the neck or arm), thus making them “ready for use” again. This procedure, also known as autotransplantation, is also used as a preventive measure in the event of radiation of the neck area, insofar as the resulting damage (hypoparathyroidism) is to be expected. If this method is successful, the patient is considered cured for the time being, even if in some cases it is only a temporary solution. If this form of treatment of hypoparathyroidism is not possible or does not work, the use of drugs is resorted to. In order to compensate for the lack of calcium caused by parathyroid hormone deficiency, hypoparathyroidism sufferers are given special calcium tablets containing a small amount of vitamin D, which normalizes the amount of calcium in the blood and the symptoms caused by hypoparathyroidism usually disappear.
Prevention
Since hypoparathyroidism is not caused by a poor diet or lifestyle in most cases, prevention is difficult. In any case, even if there are no signs of hypoparathyroidism, a possible magnesium deficiency and an excess of vitamin D should be ruled out and examined by a physician.
Follow-up
The main purpose of follow-up for hypoparathyroidism is to help ensure compensation for calcium deficiency. Therefore, patients suffering from hypoparathyroidism are prescribed appropriate calcium tablets with vitamin D. These agents are to be taken consistently in the follow-up phase so that the calcium level in the blood normalizes and the previous symptoms recede. In order to promote healthy development after the actual therapy, those affected should change their diet. Calcium-rich foods help prevent the disease. Dairy products, green vegetables and many types of nuts soon make patients feel better. Too much fat and phosphates, on the other hand, are taboo, as they place an unnecessarily heavy burden on the organism. Patients should also avoid alcohol. Light activities in the fresh air are also part of a healthy life. This increases the sense of well-being. Attentiveness and a good health consciousness ensure that those affected also feel better psychologically. This also applies in the case of mild parathyroid hypofunction, which can quickly lead to distressing symptoms. Close observation of the physical warning signals helps to detect an acute deterioration of the condition at an early stage and to avoid it effectively. That is why patients should thoroughly study the typical signs of the disease for successful follow-up.
Here’s what you can do yourself
Parathyroid insufficiency complicates daily life mainly through symptoms traceable to hypocalcemia. The best possible prophylactic option is a deliberate, calcium-rich diet. Calcium-supplying foods such as dairy products, green vegetables (composite and cruciferous vegetables), and certain types of nuts should be the main component of meals. Foods high in fat and phosphates should be avoided, as well as alcohol consumption. The bioavailability of calcium is only given in the presence of sufficient vitamin D, so daily moderate outdoor exercise is advised. The general quality of life of patients improves several times with mindful nutrition. Mild hypocalcemia results in moderate but psychologically distressing symptoms. These symptoms can be significantly reduced via proper nutrition in combination with drug therapy. Severe hypocalcemia can usually only be treated as an inpatient. If those affected pay close attention to their physical warning signs, acute conditions can be effectively avoided. Strenuous, sweaty activities deplete the body of important minerals. During increased exercise, long excursions or work days, people can resort to consuming calcium-containing mineral water or calcium supplements. Carrying and consuming them not only reduces the risk of acute deficiency, but also reduces potential anxiety. As with any chronic disease, it helps to seek contact with other sufferers or even seek therapeutic help.