Hypoparathyroidism presents the following signs and symptoms:

• Pain in the abdomen
• Cataract 
• Muscle cramps and carpopedal spasms 
• Weakening of tooth enamel
• Painful menstrual cycle
• Seizures [7]
• Tingling sensation in the hands, fingers and feet
• Brittle nails
• Dry skin
• Depression
• Fatigue
• Loss of hair and hair thinning in areas of eyebrows
• Headache

A complete physical examination should be done in order to study the signs of hypoparathyroidism. A blood work would reveal levels of calcium, phosphorus, magnesium and PTH. Urine test is done to see whether the body is excreting excessive amount of calcium through urine. For diagnosing hypoparathyroidism in children, it is necessary to check for signs of appropriate teeth and mental development.

Treatment of hypoparathyroidism is directed towards normalizing the levels of calcium and phosphorus and controlling the symptoms. Combination of drug therapy and modifications in dietary regime can help in better management of the disease condition. The following are methods employed for treating hypoparathyroidism:

• Drugs to increase calcium and vitamin D levels in the body [8].
• A diet rich in calcium is advised. In addition, individuals are also advised to avoid foods rich in phosphorus.
• In case the patient is experiencing serious symptoms, an immediate administration of calcium via the intravenous route is suggested.

If the disease is diagnosed on time and treatment initiated then the prognosis is usually good. However, if the condition has adversely affected the bones, eyes and brain calcification then these can seldom be treated.

Complications

Several complications can set in as a result of poor management of hypoparathyroidism. These include the following conditions:

• If children are affected then they can suffer from poor mental development, delayed growth and abnormal teeth formation.
• Deposition of calcium in the brain.

These were some of the irreversible complications of hypoparathyroidism. Some of the reversible complications that can be managed well with appropriate treatment regime include:

• Hypercalcemia that occurs due to excessive administration of calcium and vitamin D as the part of treatment process thus interfering with kidney functioning.
• Arrhythmia 
• Convulsions accompanied by loss of consciousness
• Paresthesias
• Tetany characterized by spasms in the hands and fingers which can get very painful. If the spasms occur in the throat then it can cause life threatening situations.

Hypoparathyroidism is a result of insufficient production of PTH which occurs due to the following factors:

• Acquired hypoparathyroidism is a condition wherein an injury to the gland is the major cause of PTH deficiency. In addition, surgical procedures to remove the glands (total thyroidectomy) as part of the treatment procedure for certain disease conditions also induce development of hypoparathyroidism [1]. 
• Hypoparathyroidism is also caused due to an autoimmune disease condition (e.g. autoimmune hypoparathyroidism) in which the body regards the glands as foreign bodies and sets out antibodies to destroy them [2]. As a result, the glands do not produce the hormone.
• Congenital hypoplasia of the parathyroid gland like Di George syndrome is a disorder affecting only children wherein the parathyroid glands are absent which results in hypoparathyroidism. It is a heredity condition, wherein the parathyroid glands are either absent from birth or they do not produce sufficient PTH [3].
• Cancer treatment of the face and neck causes extensive exposure to radiations and chemotherapy that leads to destruction of the parathyroid glands.
• Insufficient serum magnesium levels are yet another factor for development of hypoparathyroidism. Under normal circumstances optimal levels of magnesium are required for the parathyroid glands to produce PTH. When there are low levels of magnesium in the blood, the gland fails to produce sufficient hormones.
• Familial hypoparathyroidism occurs as a secondary condition to other endocrine disorders. 

Hypoparathyroidism is an uncommon condition and is considered to be a rare disease as stated by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). It has been estimated that less than 200,000 individuals in the US are affected by this rare disease condition.

The age of onset completely depends on the causative factor. In the United States, approximately 7.6% of those who undergone thyroidectomy surgery will result in hypoparathyroidism [4].

PTH is important for the regulation of the minerals namely calcium and phosphorus. It also helps in maintaining the vitamin D levels in the bone. Therefore, insufficient levels of PTH would severely affect the calcium–phosphorus balance. In order to maintain appropriate serum calcium levels, it is necessary that fluctuations of the calcium levels in the intestinal tract, bones and kidney be properly regulated.

Hypocalcemia in hypoparathyroidism causes signs and symptoms of neuromuscular irritability [5]. Calcium along with PTH and vitamin D3 are involved in calcium regulation. The progressive deficiency in calcium and vitamin D3 in the serum will result in an increase in the volume of cancellous bones and an increase in the trabecular width in flat bones making them more brittle [6].

In addition, PTH also plays a vital role in regulation of distal renal tubular calcium reabsorption. Low concentration of serum calcium stimulates PTH secretion; whereas phosphate reabsorption mechanism is also regulated by PTH. Therefore, any imbalance in the PTH levels grossly affects the serum phosphate and calcium levels.

So far, no preventive steps have been designed to avoid hypoparathyroidism. However, if individuals are undergoing neck surgery, then they should discuss with the surgeon and take necessary precautions in order to avoid any damage to the parathyroid gland.

Surgeons and endocrinologists must work hand in hand during the surgical removal of the thyroid gland to reduce incidence and complications of hypoparathyroidism [9]. A good surgical technique is paramount during the performance of total thyroidectomy and the autotransplatation of PTH gland during its inadvertent removal is as important in its prevention [10].

Hypoparathyroidism is a condition characterized by low levels of parathyroid hormone (PTH). In this condition, the parathyroid glands fail to produce optimal levels of PTH causing its deficiency. PTH is known to play a vital role in maintaining the levels of two minerals namely calcium and phosphorus.

A deficiency of PTH would thus disrupt the mineral balance and cause low levels of ionized calcium in blood and bones and high serum phosphorus levels. It is an uncommon condition and gets corrected through an appropriate treatment plan.

Definition

Hypoparathyroidism is an uncommon condition characterized by low levels of parathyroid hormone. It occurs as a result of injury or damage to the parathyroid glands.

Cause

Injury to the neck and thyroid during surgical procedures may lead to the development of hypoparathyroidism. In rare cases, this disorder occurs as a secondary condition to radioactive iodine treatment for hyperthyroidism or is inherited.

Symptoms

Symptoms of hypoparathyroidism include abdominal pain, tingling sensation in the hands and legs, stunted growth, calcification in the brain, muscle cramps, dry hair, dry scalp, improper development of tooth enamel in children, cataracts, brittle nails and seizures.

Diagnosis

Diagnosis of this condition consists of careful examination of the symptoms and blood work to assess the calcium and phosphorus levels. Urine test to determine the levels of calcium excreted through urine is also done.

Treatment

Treatment is geared towards administration of oral supplements to normalize the calcium and vitamin D levels. Consuming diet rich in calcium and low in phosphorus is advised.

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