Hypoparathyroidism is characterized by low levels of the parathyroid hormone (PTH), which is responsible for controlling the levels of calcium in the blood.
As such, the lack of this hormone causes the levels of calcium to drop, a condition known as hypocalcemia, which is associated with a wide range of symptoms, from numbness in the fingers and toes to seizures and severe muscle pain to hair, skin, nail, and dental problems.
In addition to the physical symptoms of hypoparathyroidism, the rare disease can cause behavioral issues, and can lead to cataracts and heart problems.
Tetany and other muscle symptoms
Tetany — cramps or spasms in the muscles — is characterized by an abnormally high excitability of the nerve cells. It is usually caused by hypocalcemia and results in abnormal muscle contractions, as well as uncontrollable twitching or spasms of muscles, particularly those around the mouth, hands, feet, and throat. Patients also may experience paresthesia, or tingling sensations in their fingers, toes, and lips.
Seizures are periods of abnormal electrical activity in the brain that can cause changes in movements, behavior, and consciousness. This symptom may be explained by lower calcium concentrations outside of the cells and by the calcifications — or calcium deposits — that occur in the brain.
Low levels of calcium commonly cause extreme tiredness, or fatigue, and generalized muscle weakness. This symptom can affect patients’ ability to complete everyday tasks.
Increased fatigue in people with chronic hypoparathyroidism also was found to be associated with problems in controlling heart rate.
Hypoparathyroidism also has been associated with mood changes, anxiety, depression, and irritability, as well as confusion and loss of memory. These manifestations may pose a challenge to diagnosis as they are seen in several other conditions.
Hair, skin, nail and teeth problems
PTH has a key role in the generation and differentiation of hair follicles, the sacs under the skin from which hair grows. As such, the hair of hypoparathyroidism patients is often coarse, and may easily break and fall out. Eyebrows may be thinner in these patients, with hair loss also seen in the armpits and pubic area.
Low calcium levels also may lead to skin problems in hypoparathyroidism patients, as this mineral is important for the differentiation of keratinocytes, the main cells of the outermost skin layer. These cells are important in several biologic processes, including protection against microbial infections and wound healing. People with hypoparathyroidism may have dry, scaly, and itchy skin, as well as brittle nails that break easily.
Calcium also is known to strengthen enamel, the hard outer layer of teeth. Calcium deficiency means that hypoparathyroidism patients may have dental problems, including the underdevelopment of enamel, defects in the root’s formation, and an increased risk of dental caries or cavities.
If hypoparathyroidism is left untreated, serious symptoms may arise, such as cataracts — when the eye’s natural lens becomes cloudy — fainting, abnormal heart rhythm, and heart failure. Patients also tend to have an increased pressure inside the skull, which may cause serious headaches and vision problems.
Calcifications also may occur in the kidneys, which can lead to the development of kidney stones. This ultimately can impair kidney function.
Last updated: April 7, 2021
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