What are the symptoms of hypoparathyroidism?

Symptoms of Hypoparathyroidism

Hypoparathyroidism causes symptoms primarily through hypocalcemia-induced neuromuscular irritability, ranging from mild paresthesias to life-threatening tetany, seizures, and cardiac arrhythmias. 1

Neuromuscular Manifestations

The most characteristic symptoms result from increased neuromuscular excitability due to low calcium levels:

• Paresthesias and tingling are the most common early symptoms, typically affecting the perioral region (around the mouth), fingers, and toes 1, 2
• Muscle cramps and spasms occur frequently and can progress to severe tetany involving the hands and feet 2, 3, 4
• Tetany represents severe muscle spasms that can be life-threatening, particularly when affecting the larynx or bronchi 1
• Chvostek's and Trousseau's signs are classic physical examination findings indicating latent tetany and neuromuscular irritability 1

Neurological Symptoms

• Seizures can occur at any age, even in patients with no prior seizure history, and may be the presenting symptom 1, 2, 5
• Fatigue and irritability are common but nonspecific complaints 1
• Confusion or altered mental status can develop with severe hypocalcemia 2
• Behavioral changes including anxiety or depression may occur and are sometimes mistaken for primary psychiatric disorders 2
• Abnormal involuntary movements and various movement disorders may be triggered or worsened by hypocalcemia 1

Life-Threatening Manifestations

Laryngospasm, bronchospasm, and stridor represent medical emergencies requiring immediate treatment 1, 4:

• These respiratory complications result from severe hypocalcemia affecting airway muscle control 4
• Wheezing may accompany bronchospasm 4

Cardiac Manifestations

Hypocalcemia affects cardiac electrical activity and function:

• QT interval prolongation is detectable on electrocardiogram and increases arrhythmia risk 1, 2
• Cardiac arrhythmias including ventricular tachycardia and fibrillation can occur with severe hypocalcemia 1, 2
• Cardiomyopathy is a rare but serious complication of chronic untreated disease 1, 2

Laboratory Findings

• Low serum calcium (either total or ionized) is the hallmark finding 1
• Elevated serum phosphate occurs due to lack of PTH's phosphaturic effect 6, 3
• Low or inappropriately normal PTH levels confirm the diagnosis 6
• Hypomagnesemia may coexist and should be evaluated 1, 2

Factors That Precipitate or Worsen Symptoms

Be aware that symptoms can be triggered or exacerbated by:

• Biological stress including surgery, fracture, injury, childbirth, or infection 1, 2
• Alcohol consumption 1, 2
• Carbonated beverages, especially colas 1, 2
• Decreased oral calcium intake 1
• Perioperative periods, acute illness, puberty, and pregnancy 2

Critical Clinical Pitfalls

• Symptoms vary widely in severity from mild and chronic to acute and life-threatening, requiring individualized monitoring 1
• Hypocalcemic symptoms are frequently confused with primary psychiatric disorders, especially anxiety and depression 1, 2
• Hypocalcemia can occur or recur at any age, even if it appeared to resolve in childhood 1
• Seizures due to hypocalcemia generally resolve with appropriate calcium supplementation alone, distinguishing them from primary epilepsy 1
• Regular monitoring of calcium, magnesium, and PTH levels is essential for early detection, particularly during high-risk periods 1, 2