Hypoparathyroidism

Download the hypoparathyroidism information sheet.

Hypoparathyroidism is an uncommon condition where the parathyroid glands do not produce enough parathyroid hormone (PTH). There are four parathyroid glands located in the neck, just behind the thyroid. They have an important role in the body to produce PTH, a hormone that regulates the balance of calcium and phosphate. If there is not enough PTH produced, the absorption of calcium from the gut is reduced and too much calcium is lost in the urine. Over time this can impact bone health.

There are different causes of hypoparathyroidism that may be identified through a medical history and investigations. Causes of hypoparathyroidism include:

• Neck surgery: This is the most common cause of hypoparathyroidism. This develops due to removal of the parathyroid glands or damage to their blood supply during surgery, for example during an operation for the thyroid, throat or neck cancer.
• Radiotherapy: In large doses, radiation treatment for neck cancer can damage the parathyroid glands and over time lead to hypoparathyroidism.
• Autoimmune disease: Rarely the body’s immune system can make an antibody that affects the parathyroid gland. This can occur in combination with other autoimmune conditions.
• Hereditary: This can present at birth or in childhood, due to being born without parathyroid glands or with parathyroid glands that do not work properly. Sometimes this type of hypoparathyroidism occurs with other endocrine diseases or other medical conditions.
• Low levels of magnesium in the blood: Low levels of magnesium can affect the function of the parathyroid glands.
• Infiltration of the parathyroid glands: Very rarely the parathyroid glands may be destroyed by deposition of iron, copper or other diseases.

Sometimes despite the best efforts of your doctor a cause cannot be identified.

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The signs of symptoms of hypoparathyroidism are usually due to low calcium levels in the blood. This can include:

• Tingling or altered sensation of the fingers, toes and mouth
• Muscle aches and cramping
• Muscle twitches or spasms
• Fatigue or weakness
• Abnormal heart rhythms
• Difficulty breathing
• Seizures

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1. Medical history

Your doctor may ask you questions about your personal health and family history. This will include questions about symptoms of parathyroid disease, any previous radiation therapy or neck surgery, your pregnancy history, current and previous medications, any other medical conditions, diet and concerns.

2. Physical examination

The physical examination may include feeling the front of your neck to check for parathyroid swelling.

3. Blood tests

If you have symptoms or signs of hypoparathyroidism, the next test your doctor will do is a blood test to measure the levels of PTH, calcium, magnesium, phosphate, vitamin D and kidney function. This involves taking a small amount of blood and sending it to the lab for tests. In hypoparathyroidism, the levels of PTH and calcium are low and the phosphate usually high.

4. Electrocardiogram (ECG)

Your doctor may organise an ECG to assess your heart rhythm.

What are the complications of primary Hypoparathyroidism?

Symptoms of hypoparathyroidism (see above) due to low blood calcium levels will improve with treatment. If hypoparathyroidism is untreated for a long time, particularly in childhood, it can cause complications that do not get better. These include changes in the shape and growth of bones (including reduced adult height), calcium build-up in tissues (including in parts of the brain, called basal ganglia calcification), poor formation of teeth, cataracts and delayed mental development. It is not clear whether hypoparathyroidism causes an increased risk of bone fractures.

There can also be complications associated with the treatment of hypoparathyroidism (see treatment section).

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The goal of treatment is to relieve symptoms and to bring the calcium and phosphate levels back into a safe range to support your body’s function. Treatment involves taking calcium and vitamin D tablets regularly. This is different to other endocrine problems where treatment involves replacing the hormone that is low. Currently in Australia, we do not have any approved medications to directly replace PTH. It is important to get the balance of calcium and phosphate correct to prevent complications. Not enough calcium will lead to ongoing symptoms whilst too much calcium can lead to deposits of calcium in the kidneys causing kidney stones or a condition called nephrocalcinosis that can impair kidney function over time. Calcium can also deposit in the brain which rarely may affect the function of your nervous system.

Diet: it is recommended to follow a high-calcium, low-phosphate diet. A daily calcium intake of 1200-2000mg per day is advised, which is higher than the recommendation for the general population. A 250ml glass of milk contains 300mg of calcium and a 25g slice of tasty cheese contains 165mg. Certain foods (such as dairy) contain high amounts of both calcium and phosphate which can make this challenging. It is recommended to eat those items in moderation.

• Focus on high calcium foods: leafy green vegetables (for example, broccoli, cabbage), soya beans, tofu, nuts, grain-based or wholemeal bread, fish.
• Limit high phosphate foods: processed foods (especially processed meats), fizzy drinks (for example, cola, root beer)

Calcium: This is taken as a tablet up to three times a day. There are a few different brands of calcium tablets (for example, Caltrate or Citracal) and you may like to have a trial of each to see which one you prefer. It is important to discuss this with your doctor first as different brands contain different amounts of calcium. Close monitoring will be required when changing between brands to make sure your calcium level stays safe. If the calcium level is very low, sometimes an intravenous infusion is required at first to increase the blood calcium quickly.

Activated vitamin D (calcitriol): Calcitriol is the activated form of vitamin D and helps to maintain a normal calcium and phosphate level in the blood. This requires a prescription and is different from the vitamin D3 supplements that can be bought without a prescription from a pharmacy (see below).

Vitamin D3 (cholecalciferol): This is an inactive form of vitamin D. Without PTH you will not be able to convert vitamin D to the active form, however there are probably still some health benefits to keeping the nonactivated vitamin D level in the normal range. You may be recommended to take a vitamin D3 supplement if your nonactivated vitamin D level is low, for example less than 50nmol/L.

Magnesium: If your magnesium level is low, you will be advised to take magnesium tablets.

Thiazide diuretics: If there is too much calcium in the urine, sometimes your doctor will advise you to take a blood pressure medication (for example, hydrochlorothiazide) that is good at reducing the amount of calcium in the urine to prevent kidney problems

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Seeing your doctor or having a medical condition can be stressful. It often takes time for information to sink in, and it is very common to feel overwhelmed by what is happening. Sometimes it helps to write down questions before you see your doctor. Some questions that might be useful for you are:

• What is causing my hypoparathyroidism?
• Do I need further investigations?
• What should I do if I would like to get pregnant?
• Should my family members get tested?
• When do I need another appointment?
• What is my action plan for when I have symptoms of hypocalcaemia?

For information

Visit your doctor (GP)

Find an Endocrinologist: http://www.hormonesaustralia.org.au/find-an-endocrinologist/

For more information on parathyroid disorders during pregnancy and breastfeeding, visit “A patient parathyroid disorders guide during preconception, pregnancy and lactation”

For support

Parathyroid UK – Supporting People Living with Rare Parathyroid Conditions. (UK based but has good information)

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Antibody – A protein may by your immune system

Autoimmune disease – A condition where the body’s immune system attacks healthy cells.

Basal ganglia – An area in the brain that helps control important functions like movement

Cataracts – A common idea problem where the vision becomes cloudy

Hereditary – A condition that runs in the family.

Intravenous infusion – A liquid medication administered directly into the vein. This is sometimes referred to as a “drip”

Nephrocalcinosis – When too much calcium is in the urine, it can deposit within the kidneys and over time impair the function of the kidney.

References

1. Brandi ML, Bilezikian JP, Shoback D, Bouillon R, Clarke BL, Thakker RV, Khan AA, Potts JT Jr. Management of Hypoparathyroidism: Summary Statement and Guidelines. J Clin Endocrinol Metab. 2016 Jun;101(6):2273-83.

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Created by Dr Elizabeth Wootton (Endocrinologist, Royal Brisbane and Women’s Hospital)

Reviewed by Dr Karen Van (Endocrinologist, Hudson Institute of Medical Research), Associate Professor Christian Girgis (Endocrinologist, Westmead Hospital and University of Sydney), Professor Roderick Clifton-Bligh (Endocrinologist, Royal North Shore Hospital and Kolling Institute of Medical Research), Dr Syndia Lazarus (Endocrinologist, Royal Brisbane and Women’s Hospital) and Mr Ken Teo (patient advocate).

Last reviewed 10 June 2026