From the Guidelines
Hypoparathyroidism, characterized by low parathyroid hormone (PTH) levels, should be managed by maintaining PTH levels within the normal range (10–65 pg/ml in children and adults) to prevent decreased bone turnover and compromised rickets healing and growth. This can be achieved by adjusting therapies such as active vitamin D and phosphate supplements. According to a study published in Nature Reviews Nephrology 1, therapies should be adjusted to keep PTH levels within the normal range.
Key Considerations
- PTH levels should be monitored regularly to ensure they remain within the normal range
- Active vitamin D therapy and phosphate supplements should be adjusted as needed to maintain normal PTH levels
- Cinacalcet, a calcimimetic, may be considered in patients with persistent hyperparathyroidism, but its use is associated with severe adverse effects and is not licensed for this indication 1
- Parathyroidectomy should be considered in patients with tertiary hypercalcaemic hyperparathyroidism
Management Strategies
- Adjust active vitamin D and phosphate supplements to maintain normal PTH levels
- Monitor PTH levels regularly to ensure they remain within the normal range
- Consider cinacalcet or parathyroidectomy in patients with persistent hyperparathyroidism, but weigh the potential benefits against the risks of adverse effects 1
Important Notes
- Hypoparathyroidism can result from various causes, including thyroid surgery, autoimmune disorders, or genetic conditions
- Lifelong management is often required to maintain normal calcium and phosphorus levels in the body
- Regular blood tests are necessary to monitor calcium levels and adjust therapies as needed 1
From the Research
Implications of Low Parathyroid Hormone (PTH) Levels
The implications of low parathyroid hormone (PTH) levels, specifically hypoparathyroidism, can be significant and far-reaching. Some of the key implications include:
- Hypocalcemia: Low PTH levels can lead to hypocalcemia, which is a condition characterized by low calcium levels in the blood 2, 3, 4.
- Hyperphosphatemia: Hypoparathyroidism can also lead to hyperphosphatemia, which is a condition characterized by high phosphate levels in the blood 3, 4.
- Increased bone mineral density (BMD): Hypoparathyroidism has been associated with increased BMD, which can be a positive outcome, but it can also lead to other complications such as calcifications in the kidney, brain, and other soft tissues 2, 3.
- Neuromuscular irritability: Hypocalcemia can cause symptoms of neuromuscular irritability, including perioral numbness, paresthesias, tingling, seizures, and bronchospasm 4.
Treatment Options
Treatment options for hypoparathyroidism include:
- Conventional therapy with calcium and vitamin D supplementation: This is the most common treatment approach, but it can have limitations and may not always be effective 2, 3, 4.
- Parathyroid hormone (PTH) replacement therapy: PTH replacement therapy has been shown to be effective in improving serum calcium levels, reducing phosphate levels, and lowering the doses of calcium and vitamin D supplementation required 2, 3, 5, 6.
- Thiazide diuretics: Thiazide diuretics can enhance renal calcium reabsorption and increase serum calcium levels, making them a useful adjunctive treatment option 4.
- Teriparatide administration: Teriparatide, a recombinant human PTH, has been shown to be effective in improving calcium profiles, reducing hypercalciuria, and improving quality of life in patients with hypoparathyroidism 5, 6.
Quality of Life
Hypoparathyroidism can have a significant impact on quality of life, with patients often experiencing symptoms such as fatigue, muscle cramps, and paresthesias. Treatment with PTH replacement therapy, including teriparatide, has been shown to improve quality of life in these patients 5, 6.