HYPOPARATHYROIDISM – Etiology, Risk Factors, Diagnostic Evaluation, Complication and Management
Hypoparathyroidism is decreased function of the parathyroid glands with under production of parathyroid hormone. This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary muscle contraction), and several other symptoms.
Hypoparathyroidism is a condition in which body secretes abnormally low levels of parathyroid hormone (parathormone). This hormone plays a key role in regulating and maintaining a balance of body’s levels of two minerals, calcium and phosphorous. This leads to abnormally low ionized calcium levels in blood and bones and to an increased amount of phosphorus.
ETIOLOGY
- Acquired hypoparathyroidism: this is most common cause of hypoparathyroidism develops after accidental damage to or removal of the parathyroid glands during surgery. Surgery maybe a treatment for diseases of the nearby thyroid gland, or for throat cancer or neck cancer.
- Hereditary hypoparathyroidism (DeGeorge syndrome): in this form, either the parathyroid glands are not present at birth, or they do not work properly.
- Autoimmune disease: in this condition in which immune system creates antibodies against the parathyroid tissues, and treats them as antigen. In the process, the parathyroid glands stop manufacturing their hormone.
- Extensive cancer radiation treatment of face or neck, which can result in destruction of parathyroid glands
- Low levels of magnesium in blood, which can affect the function of parathyroid glands. Normal magnesium levels are required for optimum secretion of parathyroid hormone.
RISK FACTORS
- Recent neck surgery, particularly if the thyroid was involved
- A family history of hypoparathyroidism
- Having certain autoimmune or endocrine conditions, such as Addison’s disease – a condition characterized by a deficit in hormone production by the adrenal glands
DIAGNOSTIC EVALUATION
- History: It begins with the diagnostic process by taking a medical history and asking about symptoms, such as muscle cramps or tingling of the extremities, recent surgeries, particularly operations involving the thyroid or neck
- Physical examination, looking for signs that suggest hypoparathyroidism, such as facial muscle twitching
- Blood tests will reveal low blood – calcium level, low parathyroid hormone level, high blood – phosphorous level, and low blood – magnesium level
- Electrocardiogram (ECG): this test involves taking electrical readings of heart’s activity. It can detect arrhythmias associated with hypocalcemia, and in turn, hypoparathyroidism
- Urine test: evaluation of a sample of urine can show whether body is excreting too much calcium
- X-rays and bone density tests these can determine whether abnormal calcium levels have affected the strength of bones
COMPLICATION
- Tetany: these cramp-like spasms of hands and fingers may be prolonged and painful. Tetany also may include muscle discomfort and twitches or spasms of the muscles of face, throat or arms. When these spasms occur in your throat, they can interfere with breathing, creating a possible emergency.
- Paresthesias: these are characterized by sensory symptoms of odd, tingling sensations or pins and needles feelings in your lips, tongue, fingers and feet
- Loss of consciousness with convulsions (grand mal seizures)
- Malformation of the teeth
- Impaired kidney function
- Heart arrhythmias and fainting
- Stunted growth (short stature)
- Slow mental development (or mental retardation) in children
- Calcium deposits in the brain
- Cataracts
MANAGEMENT
Treatments and Drugs
Oral calcium carbonate tablets
Vitamin D can help your body absorb calcium and eliminate phosphorous. The forms of vitamin D called ergocalciferol or calcitriol are recommended most often because they have a longer duration of action or are more potent than are other forms of this vitamin. Often, the required doses of vitamin D are much higher than are those used for a typical daily vitamin supplement.
Diet
- Rich in calcium. This includes dairy products, green leafy vegetables, broccoli, kale, and fortified orange juice and breakfast cereals.
- Low in phosphorous-rich items. This means avoiding carbonated soft drinks, which contain phosphorous I the form of phosphoric acid. Eggs and meats also tend to be high in phosphorous.
- Intravenous infusion: in some cases, when immediate relief of symptoms are required, administer of calcium by intravenous (IV) infusion
- Regular monitoring, regularly assessment of blood to monitor levels of calcium and phosphorous. Initially, these tests will be weekly to monthly
- Nutrition and supplements
- Following these nutritional tips may help reduce symptoms of hypoparathyroidism
- Eliminate all potential food allergens, including dairy, wheat (gluten), soy, corn, preservatives and food additives
- Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach)
- Avoid refined foods, such as white breads, pastas, and sugar
- Eat fewer red meats and more lean meats, cold water fish, tofu (soy), or beans for protein
- Use healthy cooking oils, such as olive oil or vegetable oil
- Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes and doughnuts. Also avoid French fries, onion rings, processed foods
- Limit carbonated beverages. They are high in phosphates, which can leach calcium from your bones
- Avoid coffee and other stimulants, alcohol and tobacco
- Drink 6-8 glasses of filtered water daily
- Drink soy milk for bone health unless allergic to soy
- Exercise moderately at least 30 minutes daily, 5 days a week
- A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium
- Ipriflavone (soy isoflavones) standardized extract, 200 mg 3 times a day, for bone loss. Ipriflavone can interfere with many different medications and may not be suitable for certain people with immune deficiencies
- Omega-3 fatty acids, such as fish oils, 1-2 capsules or 1-2 tablespoonful of oil daily, to help decrease inflammation and support healthy metabolism. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning drugs, such as warfarin (Coumadin) and aspirin.
NURSING MANAGEMENT
- Activity intolerance related to fatigue and decreased cognitive process
- Constipation related to decreased gastrointestinal function
- Knowledge deficit related to exposure to information about treatment program for lifelong thyroid replacement therapy
- Ineffective breathing pattern related to depression of ventilation
- Disturbed thought process related to metabolic disorder and cardiovascular and respiratory status changes
