Management of Hypoparathyroidism: Treatment Options and Strategies for Symptom Control

Hypoparathyroidism is a parathyroid hormone deficiency. It can cause hyperphosphatemia (excess phosphate in the blood), hypocalcemia (low calcium), and increased neuromuscular irritability.  

Symptoms Of Hypoparathyroidism

• Tingling sensation (fingertips, toes and lips)
• Twitching of facial muscles
• Muscle pains 
• Tiredness
• Mood changes
• Dry and rough skin
• Brittle fingernails
• Hair fall

Causes Of Hypothyroidism

• Parathyroid gland injury during surgery
• Autoimmune disorder (Addison and pernicious anemia)
• DiGeorge syndrome (underdeveloped parathyroid glands)
• Throat or neck radiotherapy 
• Low blood magnesium levels

Treatment Options For Hypoparathyroidism

Hypothyroidism treatment helps to relieve the symptoms, increase the calcium level, and regulate other minerals in your blood. Some of the treatment options are given below:

• Oral calcium supplements: Supplements can increase calcium levels in your blood and help to bring it to the normal level (8.5 to 10.5 mg/dl). However, maintaining an optimum dosage is essential in calcium supplements. 
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• Vitamin D supplement: It is mainly used to maintain calcium homeostasis. Calcitriol is available and can be given to hypoparathyroid patients by oral ingestion as capsules, liquid syrup, or intravenous injection. Laretol 0.25mcg capsules contain the active compound calcitriol and are widely prescribed. It helps regulate calcium and phosphate and maintain bone health and kidney function. These combined actions make this medication indispensable in treating conditions like hypoparathyroidism, renal osteodystrophy, and vitamin D deficiency, contributing to overall skeletal integrity and mineral homeostasis. 
• Magnesium supplements: Severe hypomagnesemia (low level of magnesium in the blood) leads to hypoparathyroidism due to impaired parathyroid hormone secretion in the individuals. Magnesium supplements play a vital role in overcoming hypoparathyroidism, associated with the magnesium level.
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• Thiazide diuretics. If your calcium levels remain low even after the treatment, or if the amount of calcium in your urine is very high, thiazide diuretics can help lower the amount of calcium lost through your urine.
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• Parathyroid hormone replacement. Parathyroid hormone is a synthetic form of parathyroid hormone that helps replace or increase the levels of PTH in the body. It helps to control the distribution of phosphate and calcium in the body. 
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• Phosphate Binders: High levels of phosphorus in the blood (hyperphosphatemia) can occur in hypoparathyroidism due to decreased renal excretion. Phosphate binders are given to limit and reduce phosphorus absorption from your diet and decrease serum phosphate levels. 
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• Calcium infusion: In severe cases where patients suffer from low calcium in the blood or during acute episodes, intravenous infusion of calcium is necessary to help the patient raise his/ her serum calcium levels. 

Strategies for symptom management

1. You must take an adequate amount of calcium and vitamin D supplements as directed by your doctor since hypocalcemia is the most common symptom of hypoparathyroidism.
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3. Hypocalcemia can cause muscle cramps and spasms. Follow the habit of stretching exercises that cause muscle relaxation. 
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5. You can also try to apply heat packs and ice packs that provide some relief to your muscles. 
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7. Another symptom is the sensation of tingling pins and needles, which is paraesthesia. You can massage and gently move the area of sensation to improve circulation. 
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9. To manage stress and associated mental illness, you are advised to be free of stress and do activities that boost your morale, like engaging in your favorite activities or hobbies. If you find it difficult, you can also seek help from psychologists or counselors. 
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11. Calcium-rich foods such as beans, almonds, and dark green leafy vegetables can help compensate for calcium deficiency during hypothyroidism.
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13. Hypoparathyroidism patients need to limit their foods, which are high in phosphorus. Foods like red meat are rich in phosphorus, which will worsen the condition of hyperphosphatemia.

Conclusion

If you are a patient with hypoparathyroidism, you require special attention, which includes taking care of medications and foods and monitoring your levels of calcium, phosphorus, and vitamin D. You are advised to meet your healthcare provider and get a personalized treatment plan for better care.