From the Research
Hypoparathyroidism should be treated with oral calcium supplements and active vitamin D, with the goal of maintaining low-normal serum calcium levels, and considering the use of recombinant human PTH(1-84) in patients who are resistant to conventional treatment. The treatment of hypoparathyroidism primarily focuses on calcium replacement and vitamin D supplementation, with the standard approach including oral calcium supplements (typically calcium carbonate or calcium citrate) at doses of 1000-2000 mg of elemental calcium daily, divided into 2-3 doses 1. Active vitamin D (calcitriol) is prescribed at 0.25-2.0 mcg daily to enhance calcium absorption. Some patients may also need magnesium supplementation if levels are low.
Key Considerations
- Blood calcium levels should be monitored regularly, aiming for low-normal ranges (8.0-8.5 mg/dL) to avoid complications of both hypocalcemia and hypercalcemia 2.
- Patients should be aware of hypocalcemia symptoms including tingling, muscle cramps, and seizures, which require immediate medical attention.
- The underlying pathophysiology involves the parathyroid glands' inability to produce adequate PTH, which normally regulates calcium homeostasis by increasing bone resorption, renal calcium reabsorption, and vitamin D activation.
- Most cases result from surgical damage during thyroid or neck operations, though autoimmune causes also exist 3.
Recent Developments
- Recombinant human PTH(1-84) has been shown to safely reduce calcium and vitamin D dosage, and increase serum calcium levels in hypoparathyroid patients, and may be considered in patients who are resistant to conventional treatment 4.
- Some studies suggest that calcium supplementation may not always be needed in patients with hypoparathyroidism, and that a "no calcium" regimen may be effective in selected patients, although this approach requires further evaluation 5.