From the Guidelines
Low parathyroid hormone (PTH) levels, also known as hypoparathyroidism, are associated with adynamic bone disease, which can lead to an increased risk of vascular calcification and hypercalcemia 1.
Clinical Significance
The clinical significance of low PTH levels includes:
- Loss of bone buffering capacity for extracellular calcium, leading to hypercalcemia 1
- Increased risk of vascular calcification 1
- Adynamic bone disease, which can lead to osteoporosis and fractures 1
Management
To manage low PTH levels, the following recommendations are suggested:
- Monitor serum calcium, phosphorus, and PTH levels every 3-6 months to adjust treatment as needed 1
- Adjust dialysate calcium concentration to individualize treatment and prevent complications 1
- Avoid excessive phosphate intake to prevent hyperphosphatemia 1
- Consider vitamin D supplementation to enhance calcium absorption, but with caution to avoid oversuppression of PTH 1
It is essential to work closely with a healthcare provider to manage low PTH levels and adjust treatment as necessary to prevent complications and ensure optimal calcium and phosphorus balance 1.
From the Research
Clinical Significance of Low Parathyroid Hormone (PTH) Levels
Low Parathyroid Hormone (PTH) levels are associated with hypoparathyroidism, a rare endocrine disorder characterized by:
- Hypocalcemia (low serum calcium levels)
- Hyperphosphatemia (elevated serum phosphate levels)
- Inappropriately normal or high urine calcium excretion
- Low urine phosphate excretion 2, 3, 4, 5, 6
Causes and Risk Factors
The most common cause of hypoparathyroidism is iatrogenic, resulting from damage to the parathyroid glands during anterior neck surgery 3, 4, 5, 6. Other causes include:
- Congenital or acquired disorders
- Autoimmune diseases
- Genetic abnormalities
- Destruction or infiltrative disorders of the parathyroids
- Impaired secretion of PTH due to hypomagnesemia or hypermagnesemia 3
Clinical Manifestations
Clinical manifestations of hypoparathyroidism include:
- Neuromuscular irritability
- Perioral numbness
- Paresthesias
- Tingling
- Seizures
- Bronchospasm 3, 6
- Renal dysfunction
- Nephrocalcinosis
- Kidney stones
- Extracellular calcifications of the basal ganglia
- Posterior subcapsular cataracts
- Low bone turnover
- Increased bone density 4, 5, 6
Treatment and Management
Treatment of hypoparathyroidism typically involves:
- Supplementation with calcium and active vitamin D
- Goal albumin-corrected serum calcium level in the low-normal range of 8-9 mg/dl 4
- Thiazide diuretics to enhance renal calcium reabsorption and increase serum calcium 3
- Parathyroid hormone replacement therapy, such as recombinant human PTH(1-84), for selected patients who are not well controlled on standard therapy 2, 4, 5, 6