People can use methods such as dietary changes, supplements, diuretics, and hormone replacement to manage low parathyroid hormone levels.
Hypoparathyroidism is a rare condition in which the parathyroid gland does not produce enough parathyroid hormone (PTH). This hormone plays a role in metabolism, and loss of PTH activity leads to abnormally low levels of calcium (hypocalcemia) and high levels of phosphorus (hyperphosphatemia) in the blood.
This condition can affect a variety of organs throughout the body and lead to a range of symptoms, including:
- muscle weakness or cramps
- excessive nervousness
- headaches
- uncontrollable muscle twitching or spasms, particularly in the extremities
- tingling or numbness in the fingers, toes, or lips
- fatigue
- skin, hair, and nail changes
Hypoparathyroidism occurs after damage to the parathyroid gland or the loss of the gland. This can occur as a result of removal or injury during surgery, autoimmunity, or radiation therapy to the head or neck. In rare cases, people may be born with hypoparathyroidism as a result of genetics.
There is no cure for hypoparathyroidism, but a person can typically manage the symptoms with supplements and dietary changes. In general, the goal is to bring calcium and phosphate levels into normal ranges. Some people may also benefit from PTH replacement therapy with newer medications, though not every person will need these medications.
Read on to learn more about how people can manage hypoparathyroidism and help relieve the symptoms.
In most cases, calcium supplements are a first-line treatment for hypoparathyroidism.
Several types of calcium supplements are available. They vary in their dosage and in how the body absorbs them. A healthcare professional can help determine the right calcium supplement and dosage for a person’s specific needs. A person will typically take calcium supplements two or three times per day with meals.
In cases of severe hypocalcemia, intravenous (IV) calcium may be necessary to provide immediate relief. However, healthcare professionals typically do not recommend high doses of calcium because they can lead to digestive side effects such as constipation.
In general, the goal of calcium supplementation is to return a person’s calcium levels to within the lower range of normal. This helps prevent the potential complications of hypercalcemia, which can include:
- digestive issues
- bone and muscle problems
- kidney problems
- difficulty with thinking
- heart problems
A healthcare professional may check a person’s calcium levels using a blood test or a urine test. Once a person’s symptoms have resolved, a healthcare professional may recommend testing every 6 to 12 months. People who are pregnant or breastfeeding will need testing
Activated vitamin D supplements can also help restore calcium to normal levels. A variety of vitamin D formulations are available on the market, but calcitriol is the main one used to treat hypoparathyroidism because it is the active form of the vitamin. It is available only with a prescription.
Other types of vitamin D are inactive forms that require activation in the body, and hypoparathyroidism may impair these processes.
Healthcare professionals can check vitamin D levels with a blood test and will typically do this at the same time they are checking calcium levels.
In rare cases, hypoparathyroidism can result from abnormal magnesium levels. Healthcare professionals sometimes refer to this as functional hypoparathyroidism because it resolves once magnesium levels return to normal. A healthcare professional may recommend magnesium supplements if magnesium levels in the blood are too low.
Elevated magnesium levels can have health effects as well, including further damage to the parathyroid gland. A person should take any supplements according to the guidance of a healthcare professional who is familiar with their treatment history and health status.
In addition to supplements, dietary changes can help normalize levels of calcium and phosphate in the blood. Healthcare professionals will typically recommend a calcium-rich diet. The following foods contain high levels of calcium:
- dairy products (though these may contain high levels of phosphorus)
- breakfast cereals
- fortified orange juice
- leafy vegetables
In some cases, a healthcare professional may recommend avoiding or limiting foods that are rich in phosphorus, such as:
- meat, including fish and poultry
- nuts
- whole grains
- eggs
- beans
- carbonated soft drinks
Healthcare professionals do not usually recommend a phosphate-restricted diet for kids because it can lead to reduced intake of other key nutrients necessary to support healthy growth and development. For both adults and children, a registered dietitian can help provide nutritional guidance to support adequate nutrient intake.
If diet and supplements do not help a person manage their calcium and phosphate levels, or if a person continues to experience symptoms that affect their health and quality of life, a healthcare professional may recommend PTH replacement therapy.
PTH treatment helps compensate for the reduced activity of the parathyroid gland. However, results from studies on the use of PTH replacement therapy have been limited, and the observed effects on health and well-being have been modest.
Healthcare professionals have been using PTH to treat hypoparathyroidism with the medication 1-84 since 2015.
More recently, a prodrug version of PTH known as palopegteriparatide (Yorvipath) received approval for the treatment of hypoparathyroidism. This new drug is thought to be more stable than previous forms of PTH used in replacement therapy, so it helps keep PTH levels within the target range for longer.
In a clinical trial involving 84 people with hypoparathyroidism, 79% of participants who received daily injections of palopegteriparatide had normal serum calcium levels after 26 weeks, and 93% were able to stop taking conventional therapy such as calcium and vitamin D supplements.
A follow-up study found that people maintained these results for up to 52 weeks and that many participants also experienced improvements in kidney function during this time.
Healthcare professionals do not currently recommend PTH replacement therapy during pregnancy.
PTH helps regulate calcium absorption in the kidneys, and the absence of PTH can result in increased loss of calcium through the urine. Thiazide diuretics are a type of medication that results in increased calcium absorption in the kidneys and can therefore complement other types of treatment for hypoparathyroidism.
The most common types of thiazide diuretics used in hypoparathyroidism are:
- hydrochlorothiazide
- chlorthalidone
- indapamide
Healthcare professionals typically prescribe thiazide diuretics in conjunction with a low sodium diet to prevent side effects and promote calcium absorption.
People who are pregnant or who have adrenal insufficiency or certain inherited forms of hypocalcemia should not take these medications. Other types of diuretics may worsen calcium loss, so people should avoid them or stop taking them after discussion with a healthcare professional.
There is no cure for hypoparathyroidism, but people can usually manage the symptoms with a combination of dietary changes and supplements.
In some cases, medications can be helpful, but evidence supporting their use is limited so far. It is not clear whether all people with hypoparathyroidism will benefit from PTH replacement therapy.
Managing hypoparathyroidism requires careful attention to the types of supplements a person takes, including formulations and dosage. A person’s healthcare team should carefully monitor all dietary changes and supplement use. A registered dietitian can provide additional support to ensure that people meet their nutritional needs during all life stages.