Signs and Symptoms of Hypoparathyroidism
Hypoparathyroidism presents with symptoms primarily related to hypocalcemia, which causes increased neuromuscular irritability and can affect multiple organ systems. 1
Neurological and Neuromuscular Manifestations
- Paresthesia and tingling - particularly in the perioral region, fingers, and toes 1, 2
- Muscle cramps - often painful and can affect various muscle groups 1
- Seizures - can occur at any age, even in patients with no prior history of hypocalcemia 2
- Tetany - characterized by painful muscle spasms 2
- Laryngospasm and bronchospasm - potentially life-threatening manifestations 2
- Chvostek's and Trousseau's signs - clinical indicators of neuromuscular irritability due to hypocalcemia 2
- Fatigue and irritability - common but non-specific symptoms 2
- Abnormal involuntary movements - various movement disorders may be triggered or worsened by hypocalcemia 2
Cardiac Manifestations
- Prolongation of QT interval - can be detected on electrocardiogram 2
- Cardiac arrhythmias - potentially serious complication of severe hypocalcemia 2
- Cardiomyopathy - rare but serious complication of chronic untreated hypocalcemia 2
Laboratory Findings
- Low serum calcium levels - hallmark finding, either total or ionized calcium 2
- Elevated serum phosphate levels - due to lack of PTH's phosphaturic effect 1
- Low or inappropriately normal PTH levels - diagnostic criterion for hypoparathyroidism 1, 3
- Hypomagnesemia - may be an associated finding in some cases 2
Skeletal Manifestations
- Decreased bone turnover - characteristic finding in chronic hypoparathyroidism 4
- Increased bone mineral density - typically seen in untreated or undertreated cases 4
- Lower bone mineral density - can develop over time with chronic hypocalcemia 2
- Risk for osteopenia/osteoporosis - particularly with long-term disease 2
Other Manifestations
- Ectopic calcification - can affect various tissues due to elevated calcium-phosphate product 5
- Nephrocalcinosis and kidney stones - long-term complications of altered calcium metabolism 1, 5
- Brain calcifications - can develop with chronic disease 1
- Cataracts - may develop with long-standing hypoparathyroidism 5
Precipitating and Exacerbating Factors
- Biological stress - including surgery, fracture, injury, childbirth, or infection can worsen hypocalcemia 2
- Alcohol consumption - may worsen hypocalcemia 2
- Carbonated beverages - especially colas, can exacerbate hypocalcemia 2
- Decreased oral intake - can trigger or worsen symptoms 2
Clinical Pearls and Pitfalls
- Symptoms can vary widely in severity, from mild and chronic to acute and life-threatening 2
- Hypocalcemic symptoms may be confused with psychiatric disorders, especially anxiety 2
- Hypocalcemia can occur or recur at any age, even if it appeared to resolve in childhood 2
- Regular monitoring of calcium, magnesium, and PTH levels is essential for early detection and management 2
- Seizures due to hypocalcemia generally resolve with appropriate calcium supplementation alone 2
Understanding these signs and symptoms is crucial for early diagnosis and appropriate management to prevent both acute complications and long-term sequelae of hypoparathyroidism.