Your GP or Endocrinologist may also check:
What do I need to know about my medication? Hypoparathyroidism
The aim of treatment is to abolish symptoms – not
to restore ‘normal’ calcium levels in the blood.
In the absence of PTH, higher levels of calcium are
found in the urine for a given blood calcium level.
When hypoparathyroidism occurs as a complication
This can cause kidney stones or calcium deposits in
You have been diagnosed with
of surgery, the symptoms may start within hours to
the kidneys (nephrocalcinosis), even when blood
a few days after surgery. Diagnosis of a rare genetic
calcium levels are in the ‘normal’ range.
Here is some information to help you manage
The target range is between 2.0-2.25mmol/L of
adjusted calcium levels. The target range is
How is hypoparathyroidism treated?
approximate and depends on patient symptoms.
In the UK, you are likely to be prescribed:
This is achieved with an appropriate dose of
What is hypoparathyroidism?
Calcium: Mild disease can be treated with
alfacalcidol or calcitriol so that most of your
Hypoparathyroidism (HPTH) is a rare disorder in
calcium supplements alone. Each tablet of
calcium can come from your diet and you will not
which insufficient levels of parathyroid
Calcichew®, Cacit® and Calcium-500® contains
need to take too many calcium supplements. The
500mg; Adcal® contains 600mg; Sandocal-400®
Parathyroid glands are four small glands
Calcium should be taken at meal times.
which lie behind the butterfly-shaped thyroid
1000mg of elemental calcium respectively. High
It can take several months to get the balance right.
gland in your neck. These glands produce
doses (>2000mg per day) should generally be
Over time, your medication requirements can also
parathyroid hormone (PTH), which closely
change. This is often revealed by an increase or
regulates calcium levels. Calcium is important
Vitamin D: Most patients will not achieve
decrease in your calcium levels which you may feel
for functioning of nerve, muscle, bone and other cell functions.
adequate control with calcium alone. Active
forms of vitamin D such as calcitriol or
You and your doctor need to learn to recognise
alfacalcidol are favoured over high dose
your particular symptoms so that your medication
What causes hypoparathyroidism?
colecalciferol or ergocalciferol. They are easier
The commonest cause is destruction of the
to adjust in response to calcium levels.
Symptoms can still be felt when the test results are
parathyroid glands during neck surgery. The
Maintenance dose of calcitriol or alfacalcidol is
in the normal range (2.20 – 2.60 mmol/L) which is a
glands may also be damaged by the immune
typically between 0.5 – 2.0 micrograms daily.
wide range. If your levels are unstable, keep a diary
Doses up to 3.0 micrograms are often required.
of test results, doses and symptoms to help you
condition (congenital). Sometimes, the cause is
Calcitriol (Rocaltrol®) capsules come in 0.25
recognise your symptoms and understand what is
microgram (white capsules). Alfacalcidol (non-
How is the condition diagnosed?
proprietary) capsules come in 0.25, 0.5 and 1.0
What should I do in a crisis?
The initial diagnosis is often done by your GP
A ‘crisis’ can arise out of very low or very high
who will assess symptoms and take a simple
Magnesium may need to be corrected in post-
blood test to measure calcium. If this is low,
surgical HPTH if levels are found to be low.
Seek help. You can contact your Endocrine
you will be referred to an endocrinologist.
Levothyroxine (thyroid hormone replacement) is
Specialist Nurse, Endocrinologist or your GP.
needed if you had your thyroid gland removed.
Your calcium may need to be increased or cut out
Diagnosis is by means of blood tests showing:
Low parathyroid hormone (PTH) levels
medication if possible (ideally 4h, at least 2h).
You must never adjust your alfacalcidol or calcitriol
Low calcium (called adjusted or corrected
Usually, daily treatment is essential and lifelong.
However, post-surgical HPTH may resolve.
The level of calcium in your blood will need to be
checked to work out the best treatment plan.
Low calcium (hypocalcaemia)
If symptoms persist or get worse, seek help and
Living with hypoparathyroidism Early symptoms include varying degrees of
Many people with HPTH can expect to lead normal lives
‘inner shaking’, dizziness, ‘brain fog’, blurred
Stopping the tablets altogether can lead to big
vision, irritability, sensitivity to sounds,
swings in calcium levels. Do not do this on your
With permanent but mild HPTH, temporary
diarrhoea, anxiety, extreme weakness, chills,
headache. ‘Tetany’ is involuntary contraction
Severe HPTH is rare but you may experience
of muscles and this may progress to seizures.
constantly unstable calcium levels (or brittle HPTH )
Symptoms can arise through, or be made
Always carry spare medication with you.
and a range of symptoms which can be very
worse by, anxiety and over-breathing. It is
Try to maintain a month’s supply in reserve.
challenging. You should be referred to a specialist
Carry an extra supply of medication on holiday.
Carry your medication in your hand luggage
You may experience episodes of unusual fatigue or
If they don’t, try drinking some milk or
when travelling by plane, with prescription
muscle weakness. At times you will need to allow
calcium-fortified orange juice or eating
Women with HPTH can have a healthy pregnancy
If after an hour symptoms still do not
Does anything affect my calcium level?
and a normal childbirth. Calcium, vitamin D and
Diet: It is better to get your calcium from your
thyroid hormone doses may need adjusting
Stay calm and keep warm. Calcium tablets
food than from supplements. However, some
foods, e.g. too much wholemeal bread, spinach
You may need extra medication during strenuous
or tomatoes, alcohol and fizzy drinks can
physical exercise. Rarely, with severe HPTH, exercise
some of your day’s dose a little earlier
deplete calcium. Dehydration also affects
may be difficult with bone pain and muscle
than usual without actually taking more.
calcium levels: drink eight glasses of water daily.
If this keeps happening you should get a
Calcium levels can be affected by: illness,
infection, fever, sweating, vomiting, diarrhoea,
Further information and support are available from
dehydration, surgery (including dental), stress,
Hypoparathyroidism UK, a national voluntary
If you feel severely unwell or there is a
organisation, working to support people with
sudden onset of severe symptoms, don’t
(oestrogen affects calcium), exercise, and various
hypoparathyroidism and other rare parathyroid
wait, take extra medication and call your
medications (e.g. iron, aspirin, diuretics,
conditions and to promote better medical
doctor. You need to take sufficient extra
bisphosphonates, beta-blockers, PPI’s).
understanding. Hypoparathyroidism UK offers a website,
a telephone helpline, and free membership that includes
What kind of medical support will I need? Endocrinologist: Initial visits at the outpatient
department may be frequent (about 3 monthly),
GP: Your GP will continue to provide advice in- High calcium (hypercalcaemia)
between visits. Your GP will issue repeat
Warning signs include thirst, frequent
prescriptions. You are entitled to receive your
medication free of prescription charges. Your GP
stomach ache, depressed mood, constipation,
This leaflet has been prepared by the HPTH UK Clinical
MedicAlert: We recommend that you wear a Advisory Team and HPTH UK in conjunction with The
confusion. None of the symptoms are specific
MedicAlert bracelet. Hypoparathyroidism UK
Society for Endocrinology. HPTH UK Clinical Advisory Team is a group of Endocrinologists with an interest in the parathyroid glands and calcium metabolism who advise HPTH UK on medical matters.
The Journal of Pain, Vol 8, No 5 (May), 2007: pp 373-378 Available online at www.sciencedirect.com Pain in Persons With Dementia: Complex, Common, andChallengingJoseph Shega, Linda Emanuel, Lisa Vargish, Stacie K. Levine, Heide Bursch, Keela Herr,Jordan F. Karp, and Debra K. Weiner Editor’s Note: This article is one in a series of “Case Her vital signs are normal, but she lost 7 poun