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Hypoparathyroidism - Information Overview
Last reviewed: 04.07.2025
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Hypoparathyroidism, or insufficiency of the parathyroid glands, is a disease associated with changes in the secretion of parathyroid hormone, characterized by severe disturbances in phosphorus-calcium metabolism.
Cause and pathogenesis of hypoparathyroidism. The following main etiological forms of hypoparathyroidism can be distinguished (in descending order of frequency): postoperative; associated with radiation, vascular, infectious damage to the parathyroid glands; idiopathic (with congenital underdevelopment, absence of parathyroid glands or autoimmune genesis).
The most common cause of hypoparathyroidism is the removal or damage of the parathyroid glands (one or more) during imperfect thyroid surgery, which is associated with their anatomical proximity, and in some cases - with the unusual location of the glands. Their injury during surgery, disruption of the innervation and blood supply of the parathyroid glands are important. The incidence of the disease after thyroid surgery varies, according to different authors, from 0.2 to 5.8%.
[ Symptoms of Hypoparathyroidism
A patient with hypoparathyroidism is bothered by paresthesia, coldness and a crawling sensation throughout the body, especially in the extremities, convulsive twitching in the muscles, attacks of painful tonic convulsions, nervousness. In the late stages of the disease, skin changes, cataracts, calcifications in various organs and in the subcutaneous tissue appear.
Based on the course and nature of clinical features of hypoparathyroidism, two forms are distinguished: obvious (manifest), with acute and chronic manifestations, and hidden (latent).
The clinical symptoms of hypoparathyroidism consist of several groups of symptoms: increased neuromuscular conductivity and seizure readiness, visceral-vegetative and neuropsychiatric disorders.
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Diagnosis and differential diagnosis of hypoparathyroidism
Diagnosis of overt forms of hypoparathyroidism is not difficult. It is based on the anamnesis data (surgery on the thyroid or parathyroid glands, treatment with 131 1); the presence of increased neuromuscular excitability with attacks of tonic convulsions or readiness for convulsions; the presence of hypocalcemia and hypocalciuria; hyperphosphatemia and hypophosphatemia; a decrease in the level of serum parathyroid hormone; a decrease in the excretion of cAMP in the urine, reaching normal values after the administration of parathyroid hormone preparations; the presence of prolongation of the QT and ST intervals on the ECG; in later stages of the disease - the presence of cataracts and other manifestations of tissue calcification; changes in ectodermal derivatives - skin, hair, nails, tooth enamel.
In hypoparathyroidism, the total calcium content in the blood drops below 2.25 mmol/l; at a level of less than 4.75 mmol/l, calcium ceases to be detected in the urine (in the Sulkovich test). Hyperparathyroid crises occur when the calcium level in the blood serum is less than 1.9-2 mmol/l, and ionized calcium is less than 1-1.1 mmol/l.
Treatment of hypoparathyroidism
It is necessary to highlight its features during an acute attack of tetany and emphasize the need for maintenance systematic therapy in the interictal period. For the treatment of hypoparathyroid crisis, a 10% solution of calcium chloride or calcium gluconate is administered intravenously. The dose is determined by the severity of the attack and ranges from 10 to 50 ml (usually 10-20 ml). The effect should occur at the end of the infusion. Due to the possibility of intoxication (risk of collapse, ventricular fibrillation), the drug should be administered slowly. Since calcium is excreted from the body within 6-8 hours, it is advisable to repeat the injections 2-3 times a day. In the interictal period, its preparations (gluconate, lactate, chloride) are used orally at a dose of 1-2 g / day after meals.
In a crisis, parathyroidin is also used - an extract of the parathyroid glands of cattle in a dose of 40-100 U (2-5 ml) intramuscularly. The effect occurs after 2-3 hours and lasts for 24 hours with a maximum effect after 18 hours. Parathyroidin is used for maintenance therapy in a limited way due to the possibility of developing resistance and allergies. If necessary, courses of treatment are carried out for 1.5-2 months with breaks of 3-6 months.