Гіпопаратиреоз
Гіпопаратиреоз (іноді називають "гіпопара") — це рідкісний стан, при якому невеликі залози в шиї (прищитовидні залози) не працюють належним чином. Це може призвести до проблем з кістками, м'язами та нервами, але зазвичай лікується прийомом добавок.
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Hypoparathyroidism
Hypoparathyroidism is insufficient production of parathyroid hormone. Without it, blood calcium falls and phosphate rises, producing characteristic symptoms in muscles and nerves: numbness, tingling and cramps. The most common cause is damage to or removal of the glands during neck surgery. The condition is well controlled but requires continuous treatment and regular blood tests.
Symptoms
All of them follow from low calcium and the increased excitability of nerves and muscles.
- tingling and numbness around the mouth and in the fingertips and toes — usually the earliest sign;
- muscle cramps and spasms, particularly in the hands and feet, with a characteristic drawing together of the fingers;
- painful spasms in the face;
- muscle weakness and fatigue;
- anxiety, irritability, low mood, poor concentration;
- dry skin, brittle nails, hair thinning and loss;
- in severe cases: laryngeal spasm with breathing difficulty, seizures, heart rhythm disturbance;
- over the long term: cataracts, calcification in brain tissue, dental problems;
- in children: abnormal tooth development and slowed growth.
When to see a doctor
- you have developed tingling around the mouth and in your fingers, with muscle cramps;
- you have had thyroid or neck surgery and notice these symptoms — this is the most common situation and should be reported immediately;
- a blood test shows low calcium;
- you have episodes of the hands and feet drawing into spasm.
Emergency situation: difficulty breathing or a sense of tightness in the throat, a seizure, marked confusion or irregular heartbeat. In these cases immediate care is needed: calcium is given intravenously.
Causes
- neck surgery — thyroid removal, cancer surgery; the glands may be removed or damaged. The most common cause;
- autoimmune destruction of the glands;
- congenital and inherited forms, including DiGeorge syndrome;
- magnesium deficiency — without magnesium parathyroid hormone does not work; an important and reversible cause;
- radiotherapy to the neck;
- iron or copper deposition in the glandular tissue in certain diseases;
- pseudohypoparathyroidism — the hormone is produced but the tissues do not respond to it.
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How it is investigated
Calcium (total and ionised), parathyroid hormone, phosphate, magnesium, vitamin D, creatinine and urinary calcium are measured. Low calcium with a low — or unjustifiably "normal" — parathyroid hormone confirms the diagnosis. Magnesium is always checked: if it is low, it is replaced first, because otherwise calcium treatment will not work.
Depending on the case, an ECG, an eye examination for cataracts and, if needed, a head CT and genetic testing are arranged.
Treatment
The aim is to keep calcium in the lower part of the normal range: enough to prevent symptoms without overloading the kidneys.
- calcium supplements taken regularly in divided doses through the day;
- active vitamin D — alfacalcidol or calcitriol; ordinary vitamin D works less well here, because its conversion requires parathyroid hormone;
- magnesium where deficient;
- phosphate restriction in the diet if blood phosphate is high;
- thiazide diuretics in some cases, to reduce calcium loss in the urine;
- parathyroid hormone replacement in severe, poorly controlled forms;
- intravenous calcium in an acute episode, in hospital only.
After neck surgery hypoparathyroidism is often temporary: the glands recover over weeks or months and treatment can be withdrawn.
What matters in follow-up
- regular blood tests: calcium, phosphate, magnesium, creatinine and urinary calcium — even when you feel well;
- take your medication at the same time every day and do not miss doses: symptoms return quickly;
- do not change the dose yourself — too much calcium is also harmful and leads to kidney stones;
- carry information about your diagnosis and treatment regimen;
- tell any doctor about your diagnosis, including your dentist;
- drink enough water;
- discuss acid-reducing medicines with your doctor: they can affect calcium and magnesium absorption;
- have your eyes checked once a year.
Common questions
Is it permanent? After surgery it is often temporary. In autoimmune and congenital forms it is lifelong but well controlled.
Is calcium alone enough? No. Without active vitamin D, calcium is poorly absorbed.
Can I manage it through diet? Diet matters but cannot replace medication.
Why does magnesium matter? Without it parathyroid hormone does not act and calcium will not rise, whatever dose you take.
Online consultation
In an online consultation the doctor reviews your symptoms and results, checks magnesium — a common and easily corrected cause — explains the difference between ordinary and active vitamin D, helps you set up a monitoring schedule and recognise the signs that require urgent care.
This material is for information only and does not replace a medical consultation.
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