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