• Paresthesias, muscle cramps, carpopedal spasm, laryngeal stridor, convulsions, malaise, muscle and abdominal cramps, tetany, urinary frequency, lethargy, anxiety, psychoneurosis, depression, and psychosis
• History of central neck (thyroid, parathyroid, or laryngeal) resection
• Positive Chvostek and Trousseau signs
• Brittle and atrophied nails, defective teeth, cataracts
• Hypocalcemia and hyperphosphatemia, low or absent urinary calcium, low or absent circulating parathyroid hormone (PTH)
• Calcification of basal ganglia, cartilage, and arteries as seen on x-ray
• Although uncommon, occurs most often as a complication of thyroid surgery (especially for malignancy or recurrent goiter)
• Idiopathic hypoparathyroidism is an autoimmune process and can be associated with autoimmune adrenocortical insufficiency
• Rare, but possible, after radioiodine therapy for hyperthyroidism
• Neonatal tetany associated with maternal hyperparathyroidism
• Positive Chvostek or Trousseau signs (or both)
• Paresthesias, circumoral numbness, muscle cramps, irritability, carpopedal spasm, convulsions, opisthotonos, and marked anxiety
• Dry skin, brittle nails, spotty alopecia
• Low serum calcium
• Elevated serum phosphate
• Low urinary calcium
• Low or absent urinary phosphate
• Low serum PTH
• Low urine hydroxyproline
• Tetany from hyperventilation and alkalosis
• Hypocalcemia from remineralization of bones after therapy for hyperparathyroidism ("hungry bones")
• Hypocalcemia from intestinal malabsorption or renal insufficiency
• Pseudohypoparathyroidsim (X-linked syndrome with defective renal adenylyl cyclase system; associated with round face, thick body, stubby fingers, mental deficiency, and x-ray evidence of calcifications; may have associated thyroid or ovarian dysfunction; patients do not respond with phosphaturia to PTH challenge; serum concentrations of PTH are increased; can be controlled with low dose vitamin D)
• Pseudopseudohypoparathyroidism (thought to be common genetic defect as pseudohypoparathyroidism, but more mild; hypocalcemia only brought out during periods of stress such as pregnancy and rapid growth)
• History and physical exam
• Special note of prior neck surgery
• Serum and urine tests for calcium, phosphate, and PTH
• Aim of treatment is to raise serum calcium levels, to bring the patient out of tetany (if present), and to lower serum phosphate levels (to prevent metastatic calcification)
• Treatment is medical (unless parathyroid tissue was cryopreserved at the time of neck operation)
• Oral calcium (calcium, lactate, or carbonate)
• IV calcium gluconate for acute tetany (6 g mixed in 500 mL DSW infused at 1 mL/kg/h)
• Magnesium sulfate if also hypomagnesemic
• Phosphorous limited diet, and possibly phosphate binders such as aluminum hydroxide gel
• Symptomatic monitoring...
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