What is hypoparathyroidism?
Hypoparathyroidism happens when the parathyroid glands don’t produce enough parathyroid hormone (PTH). PTH is essential for keeping blood calcium in a healthy range and balancing phosphorus. When PTH is low, calcium drops (hypocalcemia) and phosphorus rises (hyperphosphatemia), which can affect nerves, muscles, the brain, heart, kidneys, and more. For a patient-friendly overview, see the Endocrine Society.
The most common cause is neck surgery, especially thyroid or parathyroid surgery, which can injure or remove the parathyroid glands. Other causes include autoimmune disease, genetic conditions (such as DiGeorge syndrome), radiation to the neck, infiltrative diseases, or severe magnesium deficiency. Learn more about causes and risk factors from the Mayo Clinic.
Because PTH regulates how your kidneys handle calcium and how your gut absorbs it (via activation of vitamin D), chronic deficiency can lead to low blood calcium, high urine calcium, and calcium-phosphate deposits in tissues if not carefully managed. A concise clinical review is available in StatPearls.
Early signs and symptoms to recognize
Symptoms of hypoparathyroidism largely come from low calcium. They can be subtle at first, then become more obvious if levels fall further. Catching these early can prevent emergencies.
- Tingling or numbness in the fingertips, toes, or around the mouth
- Muscle cramps, spasms, or twitching; hand or foot cramping (carpopedal spasm)
- Fatigue, brain fog, headaches, or difficulty concentrating
- Mood changes such as anxiety, irritability, or depression
- Dry skin, brittle nails, or hair loss
- Hoarseness or voice changes
- More severe signs: painful muscle contractions (tetany), seizures, lightheadedness or fainting, or heart rhythm changes
A thorough symptom list with plain-language explanations is provided by Mayo Clinic and the NIH’s Genetic and Rare Diseases (GARD) program.
When to seek emergency care
Call emergency services if you or someone you’re with has severe muscle spasms, seizures, trouble breathing, sudden voice/airway tightness, or faints. These can signal dangerously low calcium that needs urgent treatment.
How doctors diagnose hypoparathyroidism
Diagnosis begins with your story and exam. Your clinician will ask about recent neck surgery, autoimmune conditions, family history, and medications. They’ll also check for classic physical signs of low calcium.
Key lab tests typically include: total or ionized calcium, phosphorus, magnesium, creatinine, albumin, 25-hydroxyvitamin D, and PTH. In hypoparathyroidism, calcium is low, phosphorus is high, and PTH is inappropriately low or normal. A 24‑hour urine calcium helps assess risk of kidney stones and guide therapy. An EKG may be used to look for a prolonged QT interval when symptoms are significant.
Depending on your history, your provider may consider autoimmune testing or genetic testing (particularly in childhood-onset cases), and may review thyroid or parathyroid surgical reports. For clinician guidance, see the 2022 European Society of Endocrinology guideline.
Treatment options: from basics to advanced
Immediate care for severe hypocalcemia
Severe symptoms (seizures, tetany, arrhythmia, laryngospasm) are treated in the hospital with intravenous calcium (usually calcium gluconate), cardiac monitoring, and correction of low magnesium if present. Oxygen and airway support are provided as needed.
Daily management goals
The aim is to keep calcium in the low-normal range, reduce symptoms, and minimize urinary calcium to protect the kidneys. Standard therapy often includes:
- Oral calcium in divided doses (e.g., calcium carbonate or citrate)
- Active vitamin D (calcitriol or alfacalcidol) to improve calcium absorption
- Magnesium if levels are low, since magnesium is needed for PTH action
- Thiazide diuretics (sometimes) to lower urinary calcium, paired with a modestly lower-salt diet
Regular monitoring is crucial: blood calcium, phosphorus, magnesium, creatinine, and periodic 24‑hour urine calcium. Your regimen may need small adjustments over time to balance symptom control with kidney safety, a point emphasized in the ESE guideline.
Parathyroid hormone replacement: Yorvipath
Yorvipath (palopegteriparatide) is a parathyroid hormone therapy designed to restore more physiologic PTH levels over 24 hours, helping many adults achieve stable calcium with fewer supplements and less urinary calcium. Availability and approved uses can vary by region; consult your local regulatory and prescribing information. See the European Medicines Agency’s assessment report for details: EMA: Yorvipath.
- Who might benefit: Adults whose calcium is hard to control, who need high doses of calcium/active vitamin D, have persistent symptoms, or have kidney complications from hypercalciuria despite standard therapy.
- How it’s given: A once-daily injection, with dose adjustments based on symptoms, blood calcium, and urine calcium.
- Monitoring: Close lab follow-up when starting or changing dose to avoid over- or under-correction.
- Potential side effects: Similar to other PTH therapies—can include high or low calcium if dosing isn’t tailored, nausea, headache, and injection-site reactions. Always review the official label and speak with your clinician.
If Yorvipath isn’t available in your area, ask your endocrinologist about current options and clinical trials. Manufacturer and regulatory sites are good places to check for updates; start with the EMA and reputable medical references like StatPearls.
Lifestyle and self‑management tips
- Know your targets: Ask your provider for your personalized calcium and urine calcium goals.
- Take supplements consistently: Spread calcium through the day; take vitamin D as prescribed.
- Mind magnesium: Include magnesium-rich foods (nuts, seeds, legumes) if approved; supplement if low.
- Hydrate: Adequate fluids help protect kidneys; pair with low-sodium choices if on a thiazide.
- Keep a symptom diary: Track tingling, cramps, brain fog, sleep, and any triggers. Share at visits.
- Carry a care card: Note your diagnosis, medications, and emergency contacts.
Why early detection matters
Untreated or undertreated hypoparathyroidism can lead to seizures, heart rhythm problems, cataracts, dental issues, mood and cognitive changes, and calcifications in the kidneys and brain (e.g., basal ganglia). Conversely, overtreatment with high-dose calcium and active vitamin D can cause high urine calcium, kidney stones, and chronic kidney disease. Early recognition of symptoms, prompt testing, and careful titration of therapy reduce these risks, improve daily functioning, and may shorten hospital stays if emergencies occur.
Questions to ask your healthcare provider
- What is causing my hypoparathyroidism (surgery, autoimmune, genetic, other)?
- What calcium and phosphorus targets are right for me?
- How often should I check blood and urine tests?
- Would I be a candidate for a PTH therapy such as Yorvipath? Why or why not?
- How can I lower my urine calcium and protect my kidneys?
- What should I do if I develop warning signs of low calcium at home?