Hypoparathyroidism presents the following signs and symptoms:

• Pain in the abdomen
• Cataract 
• Muscle cramps and carpopedal spasms 
• Weakening of tooth enamel
• Painful menstrual cycle
• Seizures [7]
• Tingling sensation in the hands, fingers and feet
• Brittle nails
• Dry skin
• Depression
• Fatigue
• Loss of hair and hair thinning in areas of eyebrows
• Headache

• Fatigue

  Signs and symptoms of hypoparathyroidism include tingling or burning in the fingertips, toes, and lips; muscle aches or cramps in the legs, feet, stomach, or face; muscle twitching or spasms particularly around the mouth; and fatigue or weakness. [medicinenet.com]

  Participants with self-reported hypoparathyroidism (HPT) completed the HPT-SD, the Functional Assessment in Cancer Therapy–Cognitive Function (FACT-Cog), the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue), and the Hospital Anxiety [dovepress.com]

  […] speaking or swallowing Muscle weakness Sudden increase in blood calcium levels (hypercalcemia) Fatigue, drowsiness Urinating more than usual, which may cause you to be dehydrated and very thirsty Bone pain and broken bones Kidney stones Constipation [mdanderson.org]

  Caucasian man with a history of chronic omeprazole use and periodic seizures, who presented to the emergency department of a secondary hospital in Southern Brazil with symptoms of major depression (sadness, anhedonia, loss of appetite, insomnia, and fatigue [ncbi.nlm.nih.gov]

  Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Score at Week 26 [ Time Frame: Baseline, Week 26 ] The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) questionnaire contains 13 fatigue-related [clinicaltrials.gov]

• Weakness

  Signs and symptoms of hypoparathyroidism include tingling or burning in the fingertips, toes, and lips; muscle aches or cramps in the legs, feet, stomach, or face; muscle twitching or spasms particularly around the mouth; and fatigue or weakness. [medicinenet.com]

  Symptoms Hypoparathyroidism is characterized by weakness, muscle cramps; abnormal sensations such as tingling; burning and numbness (paresthesias) of the hands; excessive nervousness; loss of memory, impaired judgment and brain fog; headaches and uncontrollable [hypopara.org]

  Bone pain and weakness Irregular heart beat Difficulty thinking and speaking clearly If you have any of these symptoms you should contact your doctor immediately to arrange a blood test. Left untreated this can be a life threatening condition. [parathyroiduk.org]

  […] speaking or swallowing Muscle weakness Sudden increase in blood calcium levels (hypercalcemia) Fatigue, drowsiness Urinating more than usual, which may cause you to be dehydrated and very thirsty Bone pain and broken bones Kidney stones Constipation [mdanderson.org]

  A 73-year-old man with metastatic melanoma presented to the Emergency Department for the chief complaints of imbalance, general muscle weakness, abdominal pain and tingling in extremities. [ncbi.nlm.nih.gov]

• Weight Loss

  A Roux-en-Y gastric bypass resulted in important weight loss, but the preferential site of calcium absorption was bypassed. [ncbi.nlm.nih.gov]

  Loss Surgery May Present Problems for Hypoparathyroidism Patients, Report Asserts News Hypoparathyroidism Risk Increases After Thyroid, Lymph Node Surgery, Study Reports News, syndicated NORD Hosting ‘RareLaunch’ Workshops to Help Start Rare Disease [hypoparathyroidismnews.com]

  A range of non-specific gastrointestinal symptoms may include obstipation, meteorism, nausea, loss of appetite, and weight loss. Other more uncommon manifestations include stomach and duodenal ulcers as well as pancreatitis. N.B. [lecturio.com]

  The patient had exertion dyspnoea, loss of appetite, nausea, and circum-oral and extremities paresthesias for 1 year, and generalized pruritus for the last 2 months. She had no weight-loss, fever, orthopnoea or paroxysmal nocturnal dyspnoea. [sponcologia.pt]

  loss surgeries [in particular roux-en-y gastric bypass surgery where absorption of calcium and vitamin D is affected (4)]. [frontiersin.org]

• Malaise

  Herein, we describe a 60-year-old Japanese woman on hemodialysis for 35 years who presented with malaise and hypercalcemia. Severe hypoparathyroidism without parathyroidectomy and a preserved 1,25(OH)2D3 level were detected. [ncbi.nlm.nih.gov]

• Heat Intolerance

  intolerance (n = 14, 33%), and cardiovascular symptoms (n = 14, 33%). [ncbi.nlm.nih.gov]

• Dyspnea

  A 40-year-old woman with no prior history of thyroid disease presented with a six month history of progressive thyroid enlargement complicated by worsening dysphagia and positional dyspnea. [ncbi.nlm.nih.gov]

  In 2014, because of progressive dyspnea, he underwent total palliative laringuectomy, which included total thyroidectomy with extensive resection of surrounding tissues. [elsevier.es]

  Symptoms Associated with Hypercalcemia Organ system Most common symptoms and possible diagnoses Cardiovascular Angina, dyspnea, palpitations, syncope Possible diagnoses: diastolic dysfunction, dysrhythmias, hypertension, left ventricular hypertrophy, [aafp.org]

  Hoarseness or voice changes, wheezing and difficulty breathing (dyspnea) can also be associated with chronic hypoparathyroidism. Sudden, muscular spasms affecting the larynx (laryngospasm) and the bronchial tubes (bronchospasm) may also occur. [rarediseases.org]

• Stridor

  After failing medical management, she underwent supraglottoplasty with improvement of stridor, but persistent apneic events. Further work-up showed severe hypocalcemia due to hypoparathyroidism. [ncbi.nlm.nih.gov]

  Hypoparathyroidism has wide variety of presentations: from the asymptomatic patient with dramatically low serum calcium to the acutely symptomatic patient with neuromuscular irritability, tetany, painful muscle cramps, stridor, and even seizures with [bestpractice.bmj.com]

  […] hormone regulator of serum calcium and phosphorus levels in the body (1) Acute hypoparathyroidism: tetany that is mild (muscle cramps, perioral numbness, paresthesias of hands and feet) or severe (carpopedal spasm, laryngospasm, heart failure, seizures, stridor [unboundmedicine.com]

  Severe hypocalcemia presents with seizures, stridor, prolonged QTc, and tetany. Electrocardiogram (ECG) findings in severe hypocalcemia. Pathophysiology Mature PTH is an 84–amino acid protein. [emedicine.com]

• Abdominal Pain

  A 73-year-old man with metastatic melanoma presented to the Emergency Department for the chief complaints of imbalance, general muscle weakness, abdominal pain and tingling in extremities. [ncbi.nlm.nih.gov]

  Signs and symptoms include muscle cramps, abdominal pain, dry skin, brittle nails, cataracts, tetany, and convulsions Condition produced by greatly reduced function of the parathyroids possibly due to autoimmune disease or genetic factors, or by the removal [icd9data.com]

  […] affecting the glands in your child’s body Symptoms of hypoparathyroidism in children Symptoms of hypoparathyroidism in children include the following: Seizures (typically the first sign) Brittle nails and hair Tingling in the toes, fingers and lips Abdominal [rush.edu]

• Nausea

  Some have non-specific complaints due to the high calcium level such as nausea, vomiting, constipation or passing large amounts of urine. Some patients are identified after an episode of renal colic due to the passage of a kidney stone. [netdoctor.co.uk]

  Two weeks later, she presented with nausea, abdominal pain, and multiple rapidly enlarging cervical and axillary lymph nodes with elevated calcium and calcitriol. [ncbi.nlm.nih.gov]

  Side effects of Sensipar may include nausea, vomiting, rash, diarrhoea and muscle pain. 1. Hyperparathyroidism (revised February 2014). In: eTG complete. [mydr.com.au]

  […] swallowing Muscle weakness Sudden increase in blood calcium levels (hypercalcemia) Fatigue, drowsiness Urinating more than usual, which may cause you to be dehydrated and very thirsty Bone pain and broken bones Kidney stones Constipation Depression Nausea [mdanderson.org]

  Hyperparathyroidism Mainly due to hypercalcemia Bone fractures (bones become depleted of calcium) Constipation (GI system slows down …remember calcium plays a role in muscle contraction) Renal calculi formation (concentrated amounts of calcium in the blood) Nausea [registerednursern.com]

• Vomiting

  Some have non-specific complaints due to the high calcium level such as nausea, vomiting, constipation or passing large amounts of urine. Some patients are identified after an episode of renal colic due to the passage of a kidney stone. [netdoctor.co.uk]

  As soon as there is improvement in the patient's clinical condition, it is necessary to begin the treatment of comorbidities increasing the risk of renal failure or alkalosis (i.e. vomiting, diarrhea). [ncbi.nlm.nih.gov]

  […] insensibility in the fingertips, toes, and lips muscle spasms, particularly around the mouth patchy hair loss dry skin weak nails fatigue anxiety or depression painful menstruation seizures Children with hypoparathyroidism may likewise have cerebral pains, vomiting [southlakegeneralsurgery.com]

  Muscle weakness Sudden increase in blood calcium levels (hypercalcemia) Fatigue, drowsiness Urinating more than usual, which may cause you to be dehydrated and very thirsty Bone pain and broken bones Kidney stones Constipation Depression Nausea and vomiting [mdanderson.org]

  Mainly due to hypercalcemia Bone fractures (bones become depleted of calcium) Constipation (GI system slows down …remember calcium plays a role in muscle contraction) Renal calculi formation (concentrated amounts of calcium in the blood) Nausea and vomiting [registerednursern.com]

• Diarrhea

  My guess would be that the Ca was not giving her diarrhea but that she was malabsorbing the Ca due to diarrhea and rapid GI transit. Therefore if she still has significant diarrhea, I would recommend an evaluation for it. [endotext.org]

  Warning signs may be a drop in temperature, sensitivity to sound, shakiness, irritability, anxiety, diarrhea and gradually worsening muscle spasms. [parathyroiduk.org]

  As soon as there is improvement in the patient's clinical condition, it is necessary to begin the treatment of comorbidities increasing the risk of renal failure or alkalosis (i.e. vomiting, diarrhea). [ncbi.nlm.nih.gov]

  Weakness of the respiratory muscles and trouble breathing Seizures Laryngospasm (closing off of the upper airway) Heart failure Less common effects of hypoparathyroidism that specifically result from high phosphorus levels include: Constipation Nausea Diarrhea [verywellhealth.com]

  Taking lots of one type often will give a patient problems with their GI tract (diarrhea, or more commonly, constipation). [parathyroid.com]

• Loss of Appetite

  Hyperparathyroidism Symptoms Low energy Feeling tired (fatigue) Loss of appetite Muscle weakness Bone or joint pain Constipation Anxiety or depression Kidney stones Bone loss Broken bones Hypertension Parathyroid Disease Symptoms A lump in the neck Difficulty [mdanderson.org]

  […] of appetite, insomnia, and fatigue) associated with paresthesias affecting his toes. [ncbi.nlm.nih.gov]

  Other common symptoms of hyperparathyroidism include: Loss of appetite Thirst Frequent urination Lethargy and fatigue Muscle weakness Joint pain Constipation Nausea and vomiting Abdominal pain Memory loss UCSF Health medical specialists have reviewed [ucsfhealth.org]

  Some of the general symptoms that may be associated with hypercalcemia include: Weak muscles and fatigue Depression Nausea Loss of appetite Constipation and abdominal pain Feeling thirsty and frequent urination (polyuria) Lack of concentration If the [news-medical.net]

  He experienced depressed mood, decreased interest in most activities, loss of appetite (with 10% weight change), insomnia, fatigue, loss of concentration, and thoughts of death (without suicidal ideation) in the previous 3 months. [jmedicalcasereports.biomedcentral.com]

• Palpitations

  Use of beta-blocking agents, which block the action of thyroid hormone on the body, mostly to decrease rapid heart rate and palpitations. Thyroidectomy surgery instructions for patients. Hypothyroidism Treatment Thyroid hormone replacement. [brighamandwomens.org]

  Symptoms Associated with Hypercalcemia Organ system Most common symptoms and possible diagnoses Cardiovascular Angina, dyspnea, palpitations, syncope Possible diagnoses: diastolic dysfunction, dysrhythmias, hypertension, left ventricular hypertrophy, [aafp.org]

  Feeling a fluttering in the heart or chest discomfort: Severe hypoparathyroidism can cause changes to the heart rhythm, which can cause a fluttering feeling (palpitations) or discomfort in the chest. [buoyhealth.com]

  About 6 % of people with parathyroid disease (hyperparathyroidism) will discover their parathyroid problem after they show up in the emergency room with a racing heart or heart palpitations. [parathyroid.com]

  […] age 73, post-surgical, has hypothyroidism) When I’m just sleeping, I’ll wake up interruptedly on and off throughout the night. (201, male, age 26, idiopathic, taking PTH) Heart problems I always feel like my—always just feels like my heart is really palpitating [ncbi.nlm.nih.gov]

• Tachycardia

  Shortly afterwards, he had thyrotoxicosis manifesting as tachycardia and anxiety, followed by development of primary hypothyroidism. [ncbi.nlm.nih.gov]

  Affected individuals may be asymptomatic or experience syncope, seizure, or death due to arrhythmias, such as polymorphic ventricular tachycardia. Respiratory: Laryngospasm, a form of tetany, can lead to stridor and significant airway obstruction. [emedicine.com]

  In the postsurgical setting, the presentation can be acute with tetany, cramping, tachycardia, and altered mental status dominating the picture. The disorder occurs in both acquired and inherited forms. [shifrinmd.com]

  About 8% of patients with hyperparathyroidism have heart troubles (almost always this presents as a rhythm problem--arrhythmias, atrial tachycardia, PACs, etc). Usually, a medication is prescribed for this arrhythmia. [parathyroid.com]

• Hypotension

  They may also have CNS abnormalities such as depression, altered mental status, seizures, or coma, and cardiac abnormalities such as arrhythmias, hypotension, and heart failure. [aacc.org]

  Examination Findings in Persons with Parathyroid Disorders System Finding Possible cause(s) Abdominal Flank pain, tenderness Nephrolithiasis from hypercalcemia Epigastric pain, tenderness Pancreatitis from hypercalcemia, or causing hypocalcemia Cardiovascular Hypotension [aafp.org]

• Blurred Vision

  vision due to cataracts Thin, brittle nails Dry and scaly skin Seizures Diagnosis The doctor will ask about symptoms and past health. [winchesterhospital.org]

  If symptoms do develop, they may include: Weakness Muscle crampsor twitching Pain Difficulty with walking Tingling around the mouth, fingers, and toes Excessive nervousness Loss of memory Mood swings Anxiety Blurred vision due to cataracts Thin, brittle [uvahealth.com]

• Dry Skin

  skin Headaches Memory problems Depression or mood swings If hypoparathyroidism remains untreated, complications may develop, which include impaired kidney function, fainting, loss of consciousness, and heart arrhythmias or heart failure. [tgh.org]

  Signs and symptoms include muscle cramps, abdominal pain, dry skin, brittle nails, cataracts, tetany, and convulsions Condition produced by greatly reduced function of the parathyroids possibly due to autoimmune disease or genetic factors, or by the removal [icd9data.com]

  That includes: cramps and muscle aches burning, tingling, or insensibility in the fingertips, toes, and lips muscle spasms, particularly around the mouth patchy hair loss dry skin weak nails fatigue anxiety or depression painful menstruation seizures [southlakegeneralsurgery.com]

  skin and itching, dry hair Cataracts and eye problems Dental problems Kidney stones Kidney failure HIGH CALCIUM (hypercalcaemia) Vitamin D and calcium treatment requires regular blood testing as calcium levels can fluctuate in response to many factors [parathyroiduk.org]

• Alopecia

  In some hypoparathyroid conditions, there may also be pernicious anemia; dry and coarse skin; patchy hair loss (alopecia); thin, scant eyebrows; patches of skin that have lost pigment (vitiligo); and mental depression. [hypopara.org]

• Dry, Brittle Hair

  puffy skin Hypocalcemia Dry, brittle hair Hypocalcemia Candidiasis Polyglandular autoimmune syndrome with hypoparathyroidism Neuromuscular Chvostek sign Hypocalcemia Trousseau sign Hypocalcemia Emotional instability, anxiety, depression Hypo- or hypercalcemia [aafp.org]

• Muscle Cramp

  cramping muscle movements of the wrists and feet. [hypopara.org]

  Symptoms of hypoparathyroidism may include tingling in the lips, fingers, and toes; dry hair, brittle nails, and dry, coarse skin; muscle cramps and pain in the face, hands, legs, and feet; cataracts; dental problems; memory loss, headaches, and muscle [medicinenet.com]

  Symptoms: Tingling lips, hands, and feet Muscle cramps Pain in the face, legs, and feet Abdominal pain Dry hair Brittle nails Dry, scaly skin Cataracts Weakened tooth enamel in children Muscle spasms called tetany (can lead to spasms of the larynx, causing [uclahealth.org]

  Symptoms of the disease result from increased neuromuscular irritability caused by hypocalcaemia and include tingling, muscle cramps and seizures. [ncbi.nlm.nih.gov]

  Muscle cramps or spasms: Low calcium levels in the blood can also cause muscle cramps or spasms throughout the body. [buoyhealth.com]

• Muscle Spasm

  […] may ask if you’ve experienced muscle spasms, particularly in the face or hands. [endocrineweb.com]

  That includes: cramps and muscle aches burning, tingling, or insensibility in the fingertips, toes, and lips muscle spasms, particularly around the mouth patchy hair loss dry skin weak nails fatigue anxiety or depression painful menstruation seizures [southlakegeneralsurgery.com]

• Chvostek Sign

  The following are signs of hypocalcemia: Chvostek's sign (watch video) is the twitching of the facial muscles in response to tapping over the area of the facial nerve. [smartypance.com]

  sign contraction of facial muscles with percussion of the facial nerve Contraction of Cheek = Chvostek Trousseau sign carpal spasm with occlusion of brachial artery with a blood pressure Tricep spasm = Trousseau sign Studies Diagnostic testing studies [step2.medbullets.com]

  Chvostek's and Trousseau's signs. N Engl J Med. 2012; 367 (11): p.e15. doi: 10.1056/nejmicm1110569. | Open in Read by QxMD [amboss.com]

  ’s sign or Chvostek’s sign (due to hypocalcemia) KNOW how to elicit a positive Trousseau’s Sign. [registerednursern.com]

  Other symptoms may be spasms of the facial muscles (Chvostek Sign); the contraction of muscles produced by mild compression of nerves (Trousseaus Sign); malformations of the teeth, including enamel and roots of the teeth; and malformed finger nails. [hypopara.org]

• Trousseau Sign

  […] contraction of facial muscles with percussion of the facial nerve Contraction of Cheek = Chvostek Trousseau sign carpal spasm with occlusion of brachial artery with a blood pressure Tricep spasm = Trousseau sign Studies Diagnostic testing studies ↓ calcium [step2.medbullets.com]

  Chvostek's and Trousseau's signs. N Engl J Med. 2012; 367 (11): p.e15. doi: 10.1056/nejmicm1110569. | Open in Read by QxMD [amboss.com]

  What physical signs and symptoms would NOT present with these findings? (Select-all-that-apply) * A. Bronchospasm B. Constipation C. Numbness and tingling in the face D. Positive Chvostek's Sign E. Absent Trousseau's Sign F. Hypertension 5. [registerednursern.com]

• Bone Pain

  Bone pain and weakness Irregular heart beat Difficulty thinking and speaking clearly If you have any of these symptoms you should contact your doctor immediately to arrange a blood test. Left untreated this can be a life threatening condition. [parathyroiduk.org]

  Hyperparathyroidism Symptoms Low energy Feeling tired (fatigue) Loss of appetite Muscle weakness Bone or joint pain Constipation Anxiety or depression Kidney stones Bone loss Broken bones Hypertension Parathyroid Disease Symptoms A lump in the neck Difficulty [mdanderson.org]

  Bone pain is due to the activity of the parathyroid hormone on the bones, causing the calcium to be pulled OUT of the bones. [parathyroid.com]

  […] blood calcium levels may cause: vomiting drowsiness dehydration confusion muscle spasms bone pain or tenderness joint pain irregular heartbeat high blood pressure (hypertension) It can also cause a number of other possible complications, including: osteoporosis [nhs.uk]

  These include: Vomiting Dehydration Confusion and cognitive impairment Drowsiness Bone pain Muscle spasms Arrhythmia High blood pressure Loss of consciousness, coma and even death In rare cases, hyperparathyroidism can lead to the following complications [news-medical.net]

• Facial Numbness

  Physical Tingling or burning in lips, fingers, feet, and toes Facial numbness or twitching Muscle spasms, twitching, and cramping Weakness Headaches Abnormal excitability of nerves and muscles causing leg or arm spasms (tetany) Cognitive/Emotional Personality [hypoparaanswers.com]

• Psychiatric Manifestation

  Psychiatric manifestations such as mood disorders are unusual and may constitute a major diagnostic challenge, especially if the typical manifestations caused by hypocalcemia are absent. [ncbi.nlm.nih.gov]

  Aside from the 3 primary manifestations of primary hyperparathyroidism, increased calcium levels may lead to neuromuscular as well as psychiatric symptoms. [lecturio.com]

• Anhedonia

  The patient was a 22-year-old Caucasian man with a history of chronic omeprazole use and periodic seizures, who presented to the emergency department of a secondary hospital in Southern Brazil with symptoms of major depression (sadness, anhedonia, loss [ncbi.nlm.nih.gov]

  […] presentation The patient was a 22-year-old Caucasian man with a history of chronic omeprazole use and periodic seizures, who presented to the emergency department of a secondary hospital in Southern Brazil with symptoms of major depression (sadness, anhedonia [jmedicalcasereports.biomedcentral.com]

• Seizure

  Seizures may be the presenting symptoms preceding other signs of hypocalcemia such as chorea and tetany. Several types of partial motor seizures including jacksonian seizures may also be observed. [nnjournal.net]

  This case highlights the need to consider hypocalcemia in any patient with uncontrolled seizures. [ncbi.nlm.nih.gov]

• Tingling

  Early symptoms of tetany may include: Tingling or numbness in the hands and/or feet Tingling or numbness in the face especially around the mouth Irritability Brain fog Tiredness Headache Diarrhea Twitching or trembly muscles Sudden temperature drop If [parathyroiduk.org]

  Signs and symptoms of hypoparathyroidism include tingling or burning in the fingertips, toes, and lips; muscle aches or cramps in the legs, feet, stomach, or face; muscle twitching or spasms particularly around the mouth; and fatigue or weakness. [medicinenet.com]

  If you've had surgery involving your thyroid or neck, watch for signs and symptoms that could indicate hypoparathyroidism, such as a tingling or burning sensation in your fingers, toes or lips, or muscle twitching or cramping. [mayoclinic.org]

  Tingling in the hands and feet: Mild hypoparathyroidism can also cause tingling (paresthesia) in the hands and feet, also due to a low calcium level in the blood. [buoyhealth.com]

• Paresthesia

  The clinical manifestations of primary hypoparathyroidism include tetany, seizures, paresthesias, dementia, and parkinsonism. [ncbi.nlm.nih.gov]

  Symptoms Hypoparathyroidism is characterized by weakness, muscle cramps; abnormal sensations such as tingling; burning and numbness (paresthesias) of the hands; excessive nervousness; loss of memory, impaired judgment and brain fog; headaches and uncontrollable [hypopara.org]

  Tingling paresthesia in the fingers and around the mouth indicate overt tetany; carpopedal spasm is the classic muscular component of tetany. [iv.iiarjournals.org]

• Irritability

  Warning signs may be a drop in temperature, sensitivity to sound, shakiness, irritability, anxiety, diarrhea and gradually worsening muscle spasms. [parathyroiduk.org]

  Feeling irritable, anxious, or depressed: Some people with hypoparathyroidism can feel suddenly irritable, anxious, or depressed. [buoyhealth.com]

  Symptoms of the disease result from increased neuromuscular irritability caused by hypocalcaemia and include tingling, muscle cramps and seizures. [ncbi.nlm.nih.gov]

  Hypoparathyroidism has wide variety of presentations: from the asymptomatic patient with dramatically low serum calcium to the acutely symptomatic patient with neuromuscular irritability, tetany, painful muscle cramps, stridor, and even seizures with [bestpractice.bmj.com]

• Insomnia

  […] a 22-year-old Caucasian man with a history of chronic omeprazole use and periodic seizures, who presented to the emergency department of a secondary hospital in Southern Brazil with symptoms of major depression (sadness, anhedonia, loss of appetite, insomnia [ncbi.nlm.nih.gov]

  patients report significant reduction in sleep disturbances with a resolution of insomnia in 70% of patients (Figure 3).21 In addition, those with clinical insomnia sleep a significantly increased number of hours each night following surgical cure of [journals.sagepub.com]

  He experienced depressed mood, decreased interest in most activities, loss of appetite (with 10% weight change), insomnia, fatigue, loss of concentration, and thoughts of death (without suicidal ideation) in the previous 3 months. [jmedicalcasereports.biomedcentral.com]

  […] tingling sensation around the mouth and in the hands and feet, as well as muscle cramps and severe spasms known as "tetany" that affect the hands and feet.[2] Many also report a number of subjective symptoms such as fatigue, headaches, bone pain and insomnia [en.wikipedia.org]

A complete physical examination should be done in order to study the signs of hypoparathyroidism. A blood work would reveal levels of calcium, phosphorus, magnesium and PTH. Urine test is done to see whether the body is excreting excessive amount of calcium through urine. For diagnosing hypoparathyroidism in children, it is necessary to check for signs of appropriate teeth and mental development.

• Nephrolithiasis

  However, if the serum calcium is driven up to this degree by large doses of calcium and vitamin D, in the absence of PTH, massive and chronic hypercalciuria will occur, and this may lead to nephrolithiasis, nephrocalcinosis, and renal failure. [ncbi.nlm.nih.gov]

  Patients with primary hyperparathyroidism, the most common cause of hypercalcemia in outpatients, are often asymptomatic or may have bone disease, nephrolithiasis, or neuromuscular symptoms. [aafp.org]

  When serum calcium concentrations are in the upper normal range hypercalciuria may occur and this is related to nephrolithiasis, nephrocalcinosis and chronic renal insufficiency. [iv.iiarjournals.org]

  Incidence Rate of the Renal Events [ Time Frame: Baseline up to 10 years (follow-up) ] Incidence rate of the renal events will be recorded for nephrolithiasis, nephrocalcinosis, hospitalization/emergency room visits for renal events. [clinicaltrials.gov]

  Nephrolithiasis is the most common renal manifestation of primary hyperparathyroidism, resulting in the formation of calcium phosphate or calcium oxalate stones. Occasionally, it results in nephrocalcinosis with a highly unfavorable prognosis. [lecturio.com]

• Calcium Decreased

  PTH regulates the amount of calcium and phosphorus in the blood through its direct effects on the kidney and bone, where the body stores most of its calcium. Decreased PTH levels lead to low calcium levels and high phosphorus levels in the blood. [nichd.nih.gov]

  Lab work reveals a decreased serum calcium, decreased parathyroid hormone, and an elevated serum phosphate. On EKG there is a prolongation of the QT interval. Hypoparathyroidism will present with a decreased parathyroid hormone ( ↓ PTH). [smartypance.com]

  Results also indicated that serum calcium remained stable and 24-hour urinary calcium decreased by 32%. Elevation of serum calcium above the upper limit of normal was only reported in 5% of all measurements. [endocrinologyadvisor.com]

  Similarly, increases in serum proteins, as occur in multiple myeloma, can raise total serum calcium. Acidosis increases ionized calcium by decreasing protein binding, whereas alkalosis decreases ionized calcium. [msdmanuals.com]

• Prolonged QT Interval

  QT interval Diagnostic criteria ↓ serum calcium on 2+ occasions separated by 2+ weeks ↓ or undetectable PTH level Differential Pseudohypoparathyroidism distinguishing factors same symptoms of hypocalcemia and hyperphosphatemia ↑ serum PTH Treatment First-line [step2.medbullets.com]

  QT interval Serum Ca Serum Phos PTH Common Cause Hyperparathyroidism ↑ ↓ ↑ adenoma Hypoparathyroidism ↓ ↑ ↓ thyroidectomy (including parathyroid) Ectopic PTH ↑ ↓ ↓ malignancy Vit D malabsorption ↓ ↓ ↑ celiac disease, other GI disease hypo vit D with [orthobullets.com]

  Other possible investigations: ECG: prolonged QT interval which may progress to ventricular fibrillation or heart block. Echocardiogram: cardiac abnormalities (in DiGeorge's syndrome). Renal ultrasound: looking for renal calculi. [patient.info]

  In the acute setting, namely patients with symptomatic hypocalcemia, acute decrease in serum calcium <7.5 mg/dL or patients with prolonged QT interval on EKG, hypocalcemia is typically managed with a bolus of 1-2 ampules (90-180 mg elemental calcium) [raredisorders.imedpub.com]

  Cardiac manifestations are prolonged QT interval and T-wave alternans, acute cardiomyopathy, and congestive heart failure due to decreased cardiac contractility related to low serum calcium and possibly PTH deficiency, as there are PTH receptors in cardiac [frontiersin.org]

Treatment of hypoparathyroidism is directed towards normalizing the levels of calcium and phosphorus and controlling the symptoms. Combination of drug therapy and modifications in dietary regime can help in better management of the disease condition. The following are methods employed for treating hypoparathyroidism:

• Drugs to increase calcium and vitamin D levels in the body [8].
• A diet rich in calcium is advised. In addition, individuals are also advised to avoid foods rich in phosphorus.
• In case the patient is experiencing serious symptoms, an immediate administration of calcium via the intravenous route is suggested.

If the disease is diagnosed on time and treatment initiated then the prognosis is usually good. However, if the condition has adversely affected the bones, eyes and brain calcification then these can seldom be treated.

Complications

Several complications can set in as a result of poor management of hypoparathyroidism. These include the following conditions:

• If children are affected then they can suffer from poor mental development, delayed growth and abnormal teeth formation.
• Deposition of calcium in the brain.

These were some of the irreversible complications of hypoparathyroidism. Some of the reversible complications that can be managed well with appropriate treatment regime include:

• Hypercalcemia that occurs due to excessive administration of calcium and vitamin D as the part of treatment process thus interfering with kidney functioning.
• Arrhythmia 
• Convulsions accompanied by loss of consciousness
• Paresthesias
• Tetany characterized by spasms in the hands and fingers which can get very painful. If the spasms occur in the throat then it can cause life threatening situations.

Hypoparathyroidism is a result of insufficient production of PTH which occurs due to the following factors:

• Acquired hypoparathyroidism is a condition wherein an injury to the gland is the major cause of PTH deficiency. In addition, surgical procedures to remove the glands (total thyroidectomy) as part of the treatment procedure for certain disease conditions also induce development of hypoparathyroidism [1]. 
• Hypoparathyroidism is also caused due to an autoimmune disease condition (e.g. autoimmune hypoparathyroidism) in which the body regards the glands as foreign bodies and sets out antibodies to destroy them [2]. As a result, the glands do not produce the hormone.
• Congenital hypoplasia of the parathyroid gland like Di George syndrome is a disorder affecting only children wherein the parathyroid glands are absent which results in hypoparathyroidism. It is a heredity condition, wherein the parathyroid glands are either absent from birth or they do not produce sufficient PTH [3].
• Cancer treatment of the face and neck causes extensive exposure to radiations and chemotherapy that leads to destruction of the parathyroid glands.
• Insufficient serum magnesium levels are yet another factor for development of hypoparathyroidism. Under normal circumstances optimal levels of magnesium are required for the parathyroid glands to produce PTH. When there are low levels of magnesium in the blood, the gland fails to produce sufficient hormones.
• Familial hypoparathyroidism occurs as a secondary condition to other endocrine disorders. 

Hypoparathyroidism is an uncommon condition and is considered to be a rare disease as stated by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). It has been estimated that less than 200,000 individuals in the US are affected by this rare disease condition.

The age of onset completely depends on the causative factor. In the United States, approximately 7.6% of those who undergone thyroidectomy surgery will result in hypoparathyroidism [4].

PTH is important for the regulation of the minerals namely calcium and phosphorus. It also helps in maintaining the vitamin D levels in the bone. Therefore, insufficient levels of PTH would severely affect the calcium–phosphorus balance. In order to maintain appropriate serum calcium levels, it is necessary that fluctuations of the calcium levels in the intestinal tract, bones and kidney be properly regulated.

Hypocalcemia in hypoparathyroidism causes signs and symptoms of neuromuscular irritability [5]. Calcium along with PTH and vitamin D3 are involved in calcium regulation. The progressive deficiency in calcium and vitamin D3 in the serum will result in an increase in the volume of cancellous bones and an increase in the trabecular width in flat bones making them more brittle [6].

In addition, PTH also plays a vital role in regulation of distal renal tubular calcium reabsorption. Low concentration of serum calcium stimulates PTH secretion; whereas phosphate reabsorption mechanism is also regulated by PTH. Therefore, any imbalance in the PTH levels grossly affects the serum phosphate and calcium levels.

So far, no preventive steps have been designed to avoid hypoparathyroidism. However, if individuals are undergoing neck surgery, then they should discuss with the surgeon and take necessary precautions in order to avoid any damage to the parathyroid gland.

Surgeons and endocrinologists must work hand in hand during the surgical removal of the thyroid gland to reduce incidence and complications of hypoparathyroidism [9]. A good surgical technique is paramount during the performance of total thyroidectomy and the autotransplatation of PTH gland during its inadvertent removal is as important in its prevention [10].

Hypoparathyroidism is a condition characterized by low levels of parathyroid hormone (PTH). In this condition, the parathyroid glands fail to produce optimal levels of PTH causing its deficiency. PTH is known to play a vital role in maintaining the levels of two minerals namely calcium and phosphorus.

A deficiency of PTH would thus disrupt the mineral balance and cause low levels of ionized calcium in blood and bones and high serum phosphorus levels. It is an uncommon condition and gets corrected through an appropriate treatment plan.

Definition

Hypoparathyroidism is an uncommon condition characterized by low levels of parathyroid hormone. It occurs as a result of injury or damage to the parathyroid glands.

Cause

Injury to the neck and thyroid during surgical procedures may lead to the development of hypoparathyroidism. In rare cases, this disorder occurs as a secondary condition to radioactive iodine treatment for hyperthyroidism or is inherited.

Symptoms

Symptoms of hypoparathyroidism include abdominal pain, tingling sensation in the hands and legs, stunted growth, calcification in the brain, muscle cramps, dry hair, dry scalp, improper development of tooth enamel in children, cataracts, brittle nails and seizures.

Diagnosis

Diagnosis of this condition consists of careful examination of the symptoms and blood work to assess the calcium and phosphorus levels. Urine test to determine the levels of calcium excreted through urine is also done.

Treatment

Treatment is geared towards administration of oral supplements to normalize the calcium and vitamin D levels. Consuming diet rich in calcium and low in phosphorus is advised.

1. Ebrahimi H, Edhouse P, Lundgren CI, et al. Does autoimmune thyroid disease affect parathyroid autotransplantation and survival? ANZ J Surg. May 2009; 79(5):383-5.
2. Brown EM. Anti-parathyroid and anti-calcium sensing receptor antibodies in autoimmune hypoparathyroidism. Endocrinol Metab Clin North Am. Jun 2009; 38(2):437-45,
3. Goltzman D, Cole DEC. Hypoparathyroidism. In: Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Philadelphia, Pa: Lippincott-Raven; 1996:220-3.
4. Powers J, Joy K, Ruscio A, Lagast H. Prevalence and incidence of hypoparathyroidism in the United States using a large claims database. J Bone Miner Res. 2013; 28(12):2570-6 (ISSN: 1523-4681)
5. Bhadada SK, Bhansali A, Upreti V, Subbiah S, Khandelwal N. Spectrum of neurological manifestations of idiopathic hypoparathyroidism and pseudohypoparathyroidism. Neurol India. Jul-Aug 2011; 59(4):586-9.
6. Rubin MR, Dempster DW, Zhou H, et al. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res. Dec 2008; 23(12):2018-24.
7. Pesić M, Radojković D, Radenković S, Spasić M, Lukić S. Epileptic seizure as the first sign of hypoparathyroidism. Vojnosanit Pregl. 2011; 68(1):81-4 (ISSN: 0042-8450)
8. Cheung M. Drugs used in paediatric bone and calcium disorders. Endocr Dev. 2009; 16:218-232.
9. Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract. 2011; 17 Suppl 1:18-25 (ISSN: 1934-2403)
10. Paek SH, Lee YM, Min SY, Kim SW, Chung KW, Youn YK. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J Surg. 2013; 37(1):94-101 (ISSN: 1432-2323)