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Dx Hypoparathyroidism Treatments:

Hypo- and Hyper-parathyroidism

N.H.S. Choices

"Hypoparathyroidism and hyperparathyroidism are rare hormone disorders caused by the parathyroid glands in the neck producing too little (hypo) or too much (hyper) parathyroid hormone.

You have four tiny parathyroid glands, each the size of a grain of rice, in your neck behind the thyroid gland. They produce parathyroid hormone (PTH) to help control the levels of calcium, phosphorus and vitamin D within the bones and blood.

This is important, as these levels can naturally fluctuate and need to be kept within a healthy range for the body to function properly. For example, calcium levels can rise if you eat a dairy-rich meal, and can fall if you take certain medication.

The parathyroid glands are nothing to do with the thyroid gland. 'Parathyroid' means 'near the thyroid'. Parathyroid disorders should not be confused with an underactive thyroid or overactive thyroid.

Hypoparathyroidism means the parathyroid glands produce too little PTH. This causes blood calcium levels to fall (hypocalcaemia) and blood phosphorus levels to rise (hyperphosphataemia).
*You may need to take supplements for life to restore these levels."

[Editor] A common cause of hypothyroidism was accidentaly removal at thyroid surgery for Grave's Disease.

The symptoms of hypoparathyroidism vary depending on the cause, the speed at which the condition develops and the effectiveness of treatment.

People who develop hypoparathyroidism quickly (for example, after neck surgery) can have the following symptoms:
*a tingling sensation in the hands or feet or around the mouth (paraesthesia)
*unusual muscle movements, such as jerking, twitching or muscle spasms
*muscle cramps
*feeling tired, irritable, anxious or depressed

People with long-lasting (and gradually developing) hypoparathyroidism caused by other medical conditions can have:
*the above symptoms, if untreated
*eye problems, especially cataracts
*dry, thick skin
*coarse hair that breaks easily and can fall out
*fingernails that break easily, with ridges that go from left to right

In theory, very low calcium can cause fits, but this is very rare, especially if you've had the condition for some time and are being treated with medication.

The most common cause of hypoparathyroidism is accidental injury to the parathyroid glands during head and neck surgery. In about 12% of patients undergoing surgery it lasts for only a short time. Fewer than 3% of patients have permanent hypoparathyroidism. Other causes include:

*destruction of the parathyroid glands by the immune system in people with autoimmune diseases, where the body mistakenly attacks its own tissues
*radiation therapy to the neck for cancer
*surgical removal of the parathyroid glands because of cancer
*low blood magnesium levels, for example from alcoholism

Who is affected
You are more likely to develop hypoparathyroidism if you:
*have had recent thyroid or neck surgery
*have a family history of parathyroid disorder
*have Addison's disease (a rare disorder of the adrenal glands above the kidneys)
*Also, children or adults with the inherited disease DiGeorge syndrome will have hypoparathyroidism because their parathyroid glands are missing at birth.

Hypoparathyroidism is diagnosed after a blood test shows:
*low blood calcium levels
*high blood phosphorus levels
*low blood PTH levels
*If you have hypoparathyroidism an electrocardiogram (ECG) may show abnormal heart rhythms and a urine test will show high levels of urinary calcium (too much calcium leaving the body).

*Treatment aims to bring the blood levels of calcium and other minerals back to normal.
*The normal calcium range is around 2.10–2.50 millimoles per litre (mmol/L). You should aim to maintain your blood calcium levels at 2.00–2.25 mmol/L.
*Calcium carbonate and vitamin D supplements – usually calcitriol (Rocaltrol) or alfacalcidol (One-Alpha) – can be taken to restore these levels. Except for patients who have short-lived hypoparathyroidism after neck surgery, these normally have to be taken for life. Your blood levels will need to be continuously monitored with regular blood tests. The aim of therapy is to relieve symptoms and keep calcium in the near-normal or low-normal range.

It's also recommended that you follow a high-calcium, low-phosphorus diet. Good sources of calcium include:
*milk, cheese and other dairy foods
*green leafy vegetables, such as broccoli, cabbage and okra, but not spinach
*soya beans, tofu, soya drinks with added calcium
*bread and anything made with fortified flour
fish where you eat the bones, such as sardines and pilchards

Phosphorus is found in:
*red meat
*dairy foods

If your blood calcium levels drop to a dangerously low level or you keep having muscle spasms, you may need to be given calcium through a drip (directly into your vein) and your heart rhythm will be monitored until it is stable. You will then continue treatment with supplements.

Hypoparathyroidism can sometimes lead to:
*stunted growth
*poorly developed teeth
*slow mental development
Hypoparathyroidism may occur together with other autoimmune conditions such as Addison's disease and pernicious anaemia.

Excessive calcium replacement can cause complications, such as kidney stones.

Medications Used in Treatment:
1. PTH: Forteo®
2. Vitamin D Analogies: Zemplar®/paricalcitrol, Hectorol®/doxercalciferol, vitamin D3 drops

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*[Editor] Recent reports point to a need for PTH replacement more than twice daily as the hormone has a very short half-life.

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