From the Research
The initial workup for low parathyroid hormone (PTH) levels should focus on confirming hypoparathyroidism and assessing its severity, with the most recent and highest quality study 1 guiding the approach to diagnosis and management. The diagnosis of hypoparathyroidism is based on low PTH levels, hypocalcemia, and hyperphosphatemia, as noted in studies 2, 3, 1. Key laboratory tests include:
- Serum calcium
- Phosphorus
- Magnesium
- 25-hydroxyvitamin D
- Kidney function tests Treatment aims to normalize calcium levels and alleviate symptoms, with options including:
- Intravenous calcium gluconate for acute symptomatic hypocalcemia
- Oral calcium supplementation (typically calcium carbonate 1000-3000 mg elemental calcium daily in divided doses)
- Active vitamin D analogs such as calcitriol (0.25-2.0 mcg daily)
- Thiazide diuretics to reduce urinary calcium excretion The target serum calcium level should be in the low-normal range (8.0-8.5 mg/dL) to avoid complications while preventing symptoms, as recommended by 1 and supported by 3, 4. Regular monitoring of serum calcium, phosphorus, magnesium, and urinary calcium is essential to adjust therapy and prevent complications like nephrocalcinosis, as emphasized in 1 and 5. Patients should be educated about hypocalcemia symptoms and the importance of medication adherence, with the underlying cause of hypoparathyroidism, commonly post-surgical or autoimmune, influencing treatment approach and prognosis, as discussed in 2, 3, 4.