Symptoms of Hypoparathyroidism

Hypoparathyroidism is a condition that results when one or more of your parathyroid glands are underactive. Everyone has four of these tiny glands. They are found in your neck, right next to your thyroid gland.

If one or more of your parathyroid glands are underactive, they can’t make enough parathyroid hormone (PTH). The main function of PTH is to keep the calcium in your blood at normal levels. It also keeps calcium and phosphorus levels regulated.

The main symptoms of hypoparathyroidism are fatigue, intermittent muscle spasms (tetany), skin, hair, and nail changes, seizures, and brain fog. Less common symptoms include mood changes, digestive troubles, laryngospasms (vocal cord spasms) and bronchospasms (spasms of the airway), and dental issues.

Symptoms that may develop over time and might be considered complications of hypoparathyroidism are eye problems, kidney problems, heart arrhythmias (irregular heartbeat), heart failure, stunted growth and slowed mental development in children, and calcium deposits in the brain, which can lead to balance problems and frequent seizures.

This article discusses the types of hypoparathyroidism, frequent and rare symptoms of hypoparathyroidism, complications, and when to seek medical attention.

Types of Hypoparathyroidism

Hypoparathyroidism affects 37 out of 100,000 people in the United States. There are different types of hypoparathyroidism. The type you have will depend on what causes your disease.

The most common type of hypoparathyroidism is acquired type, following by autoimmune type, and then inherited and congenital types.

Acquired Type 

This type of hypoparathyroidism is acquired after removal or damage to the parathyroid glands. The parathyroid glands are small and fragile so they can easily become damaged during head or neck surgery.

You can also develop acquired type if you have a head or neck injury. Chemotherapy or radiation therapy might also damage the parathyroid glands and lead to acquired hypoparathyroidism.

Autoimmune Type 

You can develop autoimmune hypoparathyroidism if your immune system mistakenly attacks your parathyroid glands or the parathyroid hormone. It might also occur in a rare and complex inherited immune condition called autoimmune polyendocrine syndrome type 1 (APS1). Hypoparathyroidism doesn’t always occur with APS1.

Congenital Type

Some people have congenital hypoparathyroidism—a type of hypoparathyroidism that appears at birth. It is often the result of gene mutations involved in the parathyroid hormone production process. A person can also be born without parathyroid glands, which can lead to congenital hypoparathyroidism.

Familial (Inherited) Type 

Hypoparathyroidism can run in families. If you have a family history of the condition, you are more likely to have the condition. 

Frequent Symptoms 

Hypoparathyroidism affects each person differently. Symptoms of the condition include: 

Chronic Fatigue 

Fatigue is a symptom of hypoparathyroidism that is difficult to quantify. But fatigue is considered chronic if it has been present for six months or more and not relieved with rest or sleep.

It can be defined as a “feeling of weariness, tiredness, or lack of energy.” It is different than drowsiness, which describes a need for sleep.

Fatigue is one of the earliest reported symptoms of hypoparathyroidism. A 2014 online survey reported in the journal Endocrine Practice revealed that most of the 374 participants with hypoparathyroidism experienced fatigue.

Fatigue might be a main symptom of hypoparathyroidism, or it may be linked to other symptoms of the condition, including muscle spasms and pain, brain fog, or seizures.

Intermittent Muscular Cramps and Spasms 

Tetany is a symptom that involves heightened neuromuscular activity resulting from hypocalcemia (low calcium levels). It is sometimes seen on its own without any known causes, but more frequently, low calcium levels are to blame.

In hypoparathyroidism, tetany causes intermittent muscle cramps and spasms. It occurs because hypocalcemia causes changes to the balance of calcium in and out of nerve cells, making them more likely to activate. 

Muscle cramps and spasms occur because of involuntary and sudden muscle contractions. Muscle cramping and spasms are temporary but cause immobility similar to paralysis and significant pain in affected muscles.

Tetany can cause muscle spasms in the hands and feet, facial muscle spasms, and cramping in large muscles throughout the body. It can also cause tingling and burning sensations of the hands, fingertips, feet, lips, and tongue.

Paresthesia of Fingertips, Toes, and Lips

Paresthesia is the term used to describing numbing, burning, tingling, pricking, or tickling sensations throughout the body. The most common type of paresthesia is called “pins and needles.” Paresthesia in hypoparathyroidism frequently affects the fingertips, toes, and lips, but any body part can be affected.

One study reported in 2020 looked at the signs and symptoms of hypoparathyroidism to develop a measuring tool that could improve treatment and patient outcomes. Researchers interviewed 42 American adults with hypoparathyroidism.

The study found 100% of the patients had physical symptoms of hypoparathyroidism, and 88% experienced numbing and tingling (paresthesia). This was the most commonly reported symptom, followed by muscle cramping and cognitive dysfunction (both at 86%) and physical fatigue (83%).

Skin, Hair, and Nail Changes 

Hypoparathyroidism affects your skin, hair, and nails. It can lead to skin being rough and dry. It can also cause brittle nails and coarse, easily breakable hair.

An observational study reported in 2012 in the Indian Journal of Endocrinology and Metabolism looked at 21 patients with hypoparathyroidism at a tertiary hospital in Kolkata, West Bengal, India. Skin, hair, and/or nail involvement from hypoparathyroidism was present in up to 77% of people.

More than half of the study participants reported dry skin. Other skin symptoms that study participants reported were:

• Pellagra-like skin pigmentation (darker, stiffer, peeling, or bleeding skin)
• Pustular psoriasis (consisting of pustules—white bumps filled with pus near or inside red skin blotches)
• Acne-form eruption (small, raised acne-like bumps on the face, scalp, chest, and upper back)
• Bullous impetigo (a bacterial skin infection that causes large blisters at skinfolds). 

Hair loss included up to 62% losing armpit hair and more than 52% losing pubic hair. Other hair symptoms included coarsening of body hair (47.62%) and alopecia areata, which causes hair loss, (9.52%). 

The nail changes were reported with brittle and ridged nails. Nail conditions, including onycholysis (nailbed separation), onychosezia (nail splitting), and onychomadesis (nail shedding), were also reported.

Seizures

A seizure is a period of abnormal electrical activity in the brain. The type of seizure a person may experience will depend on the part of the brain affected. For example, generalized widespread seizures affect large parts of the brain, and focal seizures only affect small parts of the brain.

Generalized widespread seizures cause the muscles to stiffen and go limp, leading a person to fall to the floor. They also cause people to stare into space, experience jerking or twitching movements, and have violent convulsions with loss of consciousness.

Focal seizures can cause loss of awareness and consciousness. They cause a person to stop whatever they are doing, begin staring, and engage in somewhat purposeful activity, such as swallowing, chewing, lip smacking, or picking at clothing or other objects. 

In people with hypoparathyroidism, there is a reduction of calcium ions in the blood. Calcium is vital in helping muscles properly contract and release chemical messengers to and from nerve cells. When there are large amounts of activity in muscles and nerves, people with hypoparathyroidism and low calcium levels will experience seizures.

One reason for the seizure response might be the imbalance of calcium inside and outside of cells leading to significant changes on the surface of nerve cells that result in the nerve cells sending more signals than normal.

Another theory is the buildup of calcium in the brain leads to seizure activity, especially in people with idiopathic hypoparathyroidism. Idiopathic means having no known cause.

According to a 2018 report in the journal Case Reports in Medicine, idiopathic hypoparathyroidism (IH) is a well-known cause of hypocalcemia. This report describes a process of calcium buildup in the brain that affects between 73 to 93% of people with IH.

The degree of calcium buildup is directly linked to the severity and duration of hypocalcemia. Further, once calcium and vitamin D levels are balanced, people with IH can recover, become seizure free, and off of anti-seizure medicines.

Brain Fog 

Brain fog refers to problems with focus, concentration, and memory. It is a short-term symptom of hypoparathyroidism that comes and goes. All of its effects can take a toll on a person’s quality of life.

Episodes of brain fog will come in waves, leaving a person unable to think clearly for hours or days. People who experience brain fog often report difficulty performing day-to-day tasks, organizing their thoughts, or having conversations. Some people will also struggle with language and word choice. Their speech might be slow or confused.

Brain fog can be difficult and worrisome for the people who experience it. Fortunately, the symptoms of brain fog are not related to any permanent or diminished brain activity. 

Rare Symptoms 

There are symptoms of hypoparathyroidism that affect only some people with the condition. These include: 

Mood Changes 

People with hypoparathyroidism might experience mood disorders (such as depression), although research shows that psychiatric manifestations—including mood disorders—are unusual, especially when the effects of hypocalcemia are absent.

Some people with hypoparathyroidism may experience irritability, anxiety, and depression. But researchers are not sure if mood changes are directly caused by the condition, low calcium levels, or the psychological impact of living with a chronic health condition.

Digestive Symptoms 

Digestive symptoms are more frequently seen with other parathyroid disorders.

However, hypoparathyroidism can cause digestive symptoms and consist mostly of steatorrhea (oily, smelly stools). Steatorrhea linked to hypoparathyroidism results from fat malabsorption and can be resolved with the correction of hypoparathyroidism and normalization of calcium levels.

Idiopathic hypoparathyroidism might be associated with digestive autoimmune diseases that cause diarrhea. Studies have shown a connection between hypoparathyroidism and celiac disease, an immune disease in which a person can’t consume gluten because it can damage their small intestine.

Laryngospasms and Bronchospasms

Some people with hypoparathyroidism might experience sudden, muscular spasms of the larynx (laryngospasms) and the bronchial tubes (bronchospasm).

Having bronchospasms can restrict the flow of air in and out of the lungs. Both laryngospasms and bronchospasms are serious issues, but they are extremely rare in people with hypoparathyroidism. 

Laryngospasms can lead to hoarseness and voice changes. Bronchospasms can cause wheezing and dyspnea (difficulty breathing). 

Dental and Oral Symptoms

The parathyroid hormone plays a vital part in the metabolism of calcium and phosphorus, two important minerals that influence the mineralization of bone and teeth.

In people with hypoparathyroidism, dental abnormalities might include delays in dental growth and development, abnormally short roots, the excessive buildup of calcified tissue on the roots of one or more teeth, widening of the periodontal ligament space, and root resorption.

Hypoparathyroidism is also linked to oral candidiasis (a fungal infection of the mouth). It is an extremely rare symptom and is found in less than 5% of people with the condition. It is more often seen in inherited hypoparathyroidism.

Hypoparathyroidism In Children

Hypoparathyroidism in children is extremely rare. But most children who develop the condition have acquired or congenital types. With acquired hypoparathyroidism, affected children have had an accidental removal of part or all of the parathyroid gland. With congenital type, they were born without parathyroid glands.

In other instances, the cause of the condition in children might be idiopathic. Children might be at risk if they had a preterm birth, an autoimmune disease, or a family history of the condition.

The symptoms of hypoparathyroidism in children are similar to adult symptoms. They might include:

• Numbness around the mouth and in the hands and feet
• Painful spasms of the face, hands, arms, and feet
• Seizures
• Mood problems or disorders
• Dental problems
• Coarse, brittle hair

Complications/Subgroup Indications

Hypoparathyroidism can cause complications that can range from mild to life-threatening. These are frequently seen in cases in which hypoparathyroidism goes untreated or persists. 

In children, complications of the condition might include poor growth, abnormal teeth, and developmental delays.

Addition complications include: 

• Eye problems: These include cataracts (a clouding of the normally clear lens of the eye).
• Kidney problems: Some people may develop calcium deposits on their kidneys, which might eventually lead to impaired kidney function. Hypoparathyroidism also increases the risk for kidney stones.
• Heart problems: These include abnormal heartbeats (cardiac arrhythmias) and congestive heart failure (the heart doesn't pump blood efficiently).
• Headaches and vision changes: According to the National Organization for Rare Disorders, hypoparathyroidism has been linked to intracranial hypertension (increased pressure of the cerebrospinal fluid in the skull), which can cause severe headaches and lead to vision impairment.
• Parkinson's disease: Parkinson's disease is a disorder that affects movement. This is extremely rare, but researchers have found a connection between the two conditions. 
• Addison's disease: Addison's disease, also called adrenal insufficiency, is a rare condition where the body doesn't produce enough of certain hormones. It can coexist with autoimmune type hypoparathyroidism.
• Pernicious anemia: Pernicious anemia causes a decrease in red blood cells when the body can't absorb enough vitamin B12. It can co-occur with hypoparathyroidism.

When to See a Doctor/Go to the Hospital 

If you or a child has signs and symptoms associated with hypoparathyroidism, reach out to your doctor for an evaluation.

Seek out immediate medical attention if you or your child has a seizure or difficulty breathing. These are signs of severe hypoparathyroidism or complications of the condition. Call 911 or your local emergency number right away.

Summary 

Hypoparathyroidism is a condition where the parathyroid glands don’t make enough parathyroid hormone. This hormone manages calcium in the bloodstream and low levels of it can lead to low calcium (hypocalcemia).

There are different types of hypoparathyroidism, and the type you have depends on what has caused the condition. The most common symptoms of hypoparathyroidism are fatigue, intermittent muscular spasms (tetany), seizures, brain fog, and skin, hair, and nail changes.

Less common symptoms include mood changes, digestive troubles, laryngospasm and bronchospasm, and dental issues.

Untreated or undertreated hypoparathyroidism can lead to complications, including problems with the eyes, kidneys, and heart, stunted growth and slowed mental development in children, and calcium deposits in the brain, which can cause frequent seizures and balance problems.

A Word From Verywell

The outlook for most people with hypoparathyroidism is good if a diagnosis is made early. But complications, including dental changes, cataracts, and calcifications, are irreversible.

Hypoparathyroidism is a lifelong condition, so you will need to manage and treat it throughout your life. Most people can keep symptoms under control with long-term treatment, but that starts by recognizing symptoms of the condition.

Once you are diagnosed and the condition is being treated, your doctor will want to monitor your calcium and phosphorous levels with regular blood work. If there are changes to those levels, your doctor will adjust your calcium supplement doses as needed.