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

• Weakness

  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]

  […] following hypoparathyroidism symptoms: A burning or tingling feeling (paresthesia) in the lips, toes, or fingertips Muscle twitching and spasms (tetany) that affect the mouth, throat, arms, and hands Seizures Brittle nails Patchy hair loss Fatigue or weakness [tgh.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]

• Fatigue

  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]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019 [patientslikeme.com]

  […] lead to the following hypoparathyroidism symptoms: A burning or tingling feeling (paresthesia) in the lips, toes, or fingertips Muscle twitching and spasms (tetany) that affect the mouth, throat, arms, and hands Seizures Brittle nails Patchy hair loss Fatigue [tgh.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]

• 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]

  She had no weight-loss, fever, orthopnoea or paroxysmal nocturnal dyspnoea. She had a recently diagnosed atrial fibrillation, a past medical history of arterial hypertension, and an idiopathic pericarditis 2 years before. [sponcologia.pt]

  loss.1,18 In a case series of 37 dogs with naturally occurring primary hypoparathyroidism, the most commonly noted abnormalities at presentation (in descending order of incidence) included fever, tense or splinted abdomen, stiff gait, thinness, generalized [dvm360.com]

• 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]

• 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]

  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]

• 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]

• 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]

  Symptoms may include any of the following: Abdominal pain Brittle nails Cataracts Calcium deposits in some tissues Decreased consciousness Dry hair Dry, scaly skin Muscle cramps Muscle spasms called tetany (can affect the larynx, causing breathing difficulties [nlm.nih.gov]

  Hypoparathyroidism symptoms Call your primary care physician if you notice any of the following symptoms of hypoparathyroidism: Brittle nails and hair Tingling in the toes, fingers and lips Abdominal pain Cataracts Dry skin Muscle spasms called tetany [rush.edu]

• Nausea

  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]

  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]

  The most common side effects observed in Natpara-treated participants were sensations of tingling, tickling, pricking, or burning of the skin (paraesthesia); low blood calcium; headache; high blood calcium; and nausea. [raredr.com]

  […] be ordered to increase excretion of phosphate by GI system into the stool: Aluminum carbonate (Gelusil Amphojel) ADMINISTER after meals Parathyroid Hormone Replacement: Natpara Monitor calcium levels: can increase calcium levels too high, GI issues nausea [registerednursern.com]

  If the digestive system is affected, abdominal pain, constipation, loss of appetite and nausea are the most common symptoms. Symptoms of mental health problems may also occur. [mydr.com.au]

• Vomiting

  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]

  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]

  […] ordered to increase excretion of phosphate by GI system into the stool: Aluminum carbonate (Gelusil Amphojel) ADMINISTER after meals Parathyroid Hormone Replacement: Natpara Monitor calcium levels: can increase calcium levels too high, GI issues nausea vomiting [registerednursern.com]

  […] be wide ranging and include: depression tiredness feeling thirsty and peeing a lot feeling sick and losing your appetite muscle weakness constipation tummy pain loss of concentration mild confusion Left untreated, high blood calcium levels may cause: vomiting [nhs.uk]

  […] 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]

• Loss of Appetite

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

  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]

  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]

  The most common symptoms include: Muscle tremors or twitching Stiff gait Uncoordinated gait Anxious, restless behavior Seizures Lethargy/weakness Increased panting Loss of appetite Diagnosis of hypoparathyroidism The testing typically performed to arrive [pethealthnetwork.com]

  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]

• 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]

  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]

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

  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]

• 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]

• 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]

• 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]

  This percentage of decrease would correspond to a total calcium concentration below 6 mg/dl or an ionized calcium below 0.7 mmol/L in dogs.1,7 Although rare, a total serum calcium concentration less than 4 mg/dl can be lethal because of hypotension, decreased [dvm360.com]

• Blurred Vision

  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]

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

• Dry Skin

  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]

  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]

  Hypoparathyroidism symptoms Call your primary care physician if you notice any of the following symptoms of hypoparathyroidism: Brittle nails and hair Tingling in the toes, fingers and lips Abdominal pain Cataracts Dry skin Muscle spasms called tetany [rush.edu]

  Signs and symptoms include muscle cramps, abdominal pain, dry skin, brittle nails, cataracts, tetany, and convulsions. Definition (NCI_CTCAE) A disorder characterized by a decrease in production of parathyroid hormone by the parathyroid glands. [fpnotebook.com]

  Most symptoms of hypoparathyroidism are due to low levels of calcium in the blood and include muscle spasms, hair loss, dry skin, numbness, tingling, yeast infections and seizures. [livestrong.com]

• 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]

  Piripi, Progressive alopecia associated with hypoparathyroidism in a Jersey heifer, Veterinary Dermatology, 24, 4, (470-e112), (2013). [doi.org]

  The syndrome consists of hypoparathyroidism, Addison disease, candidiasis, and at least two of the following: insulin‐dependent diabetes, primary hypogonadism, autoimmune thyroid disease, pernicious anemia, chronic active hepatitis, steatorrhea, alopecia [asbmr.onlinelibrary.wiley.com]

  The syndrome consists of hypoparathyroidism, Addison disease, candidiasis, and at least two of the following: insulin-dependent diabetes, primary hypogonadism, autoimmune thyroid disease, pernicious anemia, chronic active hepatitis, steatorrhea, alopecia [ncbi.nlm.nih.gov]

• Dry, Brittle Hair

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

• Muscle Cramp

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

  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 [rxlist.com]

  Symptoms may include any of the following: Abdominal pain Brittle nails Cataracts Calcium deposits in some tissues Decreased consciousness Dry hair Dry, scaly skin Muscle cramps Muscle spasms called tetany (can affect the larynx, causing breathing difficulties [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]

• Muscle Spasm

  If left untreated, symptoms can include: increased brain fog, feeling very shaky inside; carpopedal spasm (painful muscle spasms or cramps of the hands and feet); high anxiety. [home.bt.com]

  Treatment In the event of severe muscle spasms, hospitalization may be warranted for calcium injections. [medical-dictionary.thefreedictionary.com]

  Symptoms may include any of the following: Abdominal pain Brittle nails Cataracts Calcium deposits in some tissues Decreased consciousness Dry hair Dry, scaly skin Muscle cramps Muscle spasms called tetany (can affect the larynx, causing breathing difficulties [nlm.nih.gov]

  The low levels of calcium lead to tetany, an increased excitability of the nerves that cause muscle spasms. [chop.edu]

• 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]

  KNOW how to elicit a positive Chvostek’s Sign (nerve hyperexcitability of the facial nerves). [registerednursern.com]

  (OH)2-vitamin levels decrease Prognosis no current hormone replacement therapy available treatment is aimed at supplementing vitamin D and calcium levels Presentation Symptoms hypocalcemia more common in hypoparathyroidism neuromuscular irritability Chvostek's [orthobullets.com]

• Trousseau Sign

  Trousseau's sign (watch video) is carpopedal spasm caused by inflating the blood-pressure cuff to a level above systolic pressure for 3 minutes. [smartypance.com]

  Positive Trousseau’s Sign D. Tingling and numbness of lips and fingers E. Calcium level of 15 mg/dL F. Phosphate level 1.2 G. Renal calculi 11. This medication is used to treat hyperparathyroidism in patients with chronic renal failure. [registerednursern.com]

  sign carpal spasm with occlusion of brachial artery with a blood pressure Tricep spasm Trousseau sign Studies Diagnostic testing studies calcium remember to correct with albumin phosphate or undetectable PTH level ECG prolonged QT interval Diagnostic [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]

• Bone Pain

  pain or tenderness joint pain irregular heartbeat high blood pressure (hypertension) It can also cause a number of other possible complications, including: osteoporosis and bone fractures kidney stones and blockage, and kidney damage or failure peptic [nhs.uk]

  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]

  pain and broken bones Kidney stones Constipation Depression Nausea and vomiting Loss of appetite Hypoparathyroidism Symptoms Numbness, tingling Muscle cramps or spasms Learn more about parathyroid disease diagnosis. [mdanderson.org]

  BONE PAIN IN PATIENTS WITH HYPERPARATHYROIDISM. Patients with persistently elevated calcium levels due to overproduction of parathyroid hormone can also have complaints of bone pain. [parathyroid.com]

  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]

• Psychiatric Manifestation

  The definitive diagnosis was primary hypoparathyroidism with psychiatric manifestations due to chronic hypomagnesemia induced by proton pump inhibitor use. [ncbi.nlm.nih.gov]

  Among all of these reported cases, psychiatric manifestations seemed predominant in settings of long-term hypoparathyroidism. [jmedicalcasereports.biomedcentral.com]

  Depression is the most common psychiatric manifestation. Diagnosis of primary hyperparathyroidism Laboratory diagnosis should be specifically highlighted. According to the definition, hyperparathyroidism is accompanied by elevated PTH values. [lecturio.com]

  Urita, Characteristics of 22q 11.2 deletion syndrome undiagnosed until adulthood: an example suggesting the importance of psychiatric manifestations, Case Reports, 2015, jun08 1, (bcr2014208903), (2015). M. Zohair Rahman and Aliya A. [doi.org]

• 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]

• 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]

• Seizure

  CONCLUSION: Thus, AED treatment cannot improve the seizure outcomes in children with parathyroid disorder, even in such cases as suspected structural seizure caused by subcortical calcifications. [ncbi.nlm.nih.gov]

  Seizures or breathing problems are an emergency. Call 911 or your local emergency number right away. Parathyroid-related hypocalcemia Clarke BL, Brown EM, Collins MT, et al. Epidemiology and diagnosis of hypoparathyroidism. [nlm.nih.gov]

• Tingling

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

  Tingling and numbness of lips and fingers E. Calcium level of 15 mg/dL F. Phosphate level 1.2 G. Renal calculi 11. This medication is used to treat hyperparathyroidism in patients with chronic renal failure. [registerednursern.com]

  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 [rxlist.com]

  Patients with hypoparathyroidism can experience numbness, tingling, muscle twitching, spasms or cramps, abnormal heart rhythm, and seizures as a consequence of low blood calcium levels. [raredr.com]

• Paresthesia

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

  Abnormal blood calcium and phosphorus levels can lead to the following hypoparathyroidism symptoms: A burning or tingling feeling (paresthesia) in the lips, toes, or fingertips Muscle twitching and spasms (tetany) that affect the mouth, throat, arms, [tgh.org]

• Irritability

  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]

  Symptoms include tetany, irritability, and muscle weakness. [medical-dictionary.thefreedictionary.com]

  Two most common etiologies are postsurgical (damage from neck or thyroid surgery) or autoimmune Accidental damage/remova l of parathyroid during neck/thyroid surgery Autoimmune destruction of the thyroid gland Patients will show signs of neuromuscular irritability [smartypance.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]

  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]

  Clinicians should remain aware that treatment with calcium supplements and vitamin D analogs increases the risk of hypercalciuria, which in turn can lead to nephrolithiasis, nephrocalcinosis, and decreased renal function.[ 10 ] Recombinant parathyroid [bcmj.org]

  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]

• Calcium Decreased

  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]

  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]

  Measured total serum calcium decreases or increases by about 0.8 mg/dL (0.2 mmol/L) for every 1 g/dL decrease or increase in albumin. [msdmanuals.com]

• Prolonged QT Interval

  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 no phosphate excretion from [orthobullets.com]

  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]

  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) of [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.

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