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Parathyroid glands
Parathyroid glands are small endocrine glands located at the rear of the thyroid gland. There are usually four of them and their total weight is estimated at approximately 100 g. These glands produce a parathyroid hormone which is called parathormone (PTH). PTH regulates calcium-phosphorus metabolism. Both a lack/deficiency and an excess of PTH results in the development of hypoparathyroidism and hyperparathyroidism, respectively.
Hypoparathyroidism
This disease results from the lack or deficiency of PTH, which leads to a decreased/ level of serum calcium and a raised level of serum phosphorus.
Causes
The most frequent cause of hypoparathyroidism is iatrogenic, which means it develops after thyroid or parathyroid surgery or following neck radiotherapy due to oncological indications. In turn, the idiopathic form of hypoparathyroidism, which is estimated at approximately a quarter of cases of the disease, is of genetic or autoimmune origin. An extremely rare cause of this disease is a pseudohypoparathyroidism as a result of tissue resistance to parathyroid hormone. Diagnosing pseudohypoparathyroidism is difficult and requires highly specialized diagnostic tests.
Symptoms and diagnostic test
A lack or deficiency of PTH results in the following symptoms: tetany or tetany-like symptoms (i.e. numbness, paraesthesia, muscle cramps) as a result of a low level of calcium and multi- organ complications such as cataracts, kidney stones, renal failure, heart rhythm disturbances or convulsions.
Diagnosis of this disease is based on a low serum level of PTH, a low level of calcium both total and ionized, and a serum increased level of phosphorus. Estimating the serum level of magnesium and vitamin D is also important.
Treatment
Diagnosing hypoparathyroidism requires constant treatment and monitoring of the patient. The vast majority of patients are treated on an outpatient basis. The following are administered orally to patients: calcium and calcitriol or any other active vitamin D metabolite in individualized doses. Occasionally, the administration of magnesium and vitamin D supplementation in indicated.
Severe hypocalcaemia (low level of calcium) requires the urgent intravenous administration of calcium.
Monitoring
Monitoring the treatment involves testing serum total and ionized calcium serum phosphorus levels, along with magnesium. Calcium urine excretion should be measured periodically. Chronic hypoparathyroidism can be diagnosed if symptoms persist for at least 12 months after neck surgery.
Please note: Recombinant human PTH (1-84) (rhPTH(1-84) parathyroid or its analogue.(Teriparatide (rhPTH(1-34) is not used in the treatment of hypoparathyroidism.
