Hypoparathyroidism is a rare condition characterized by insufficient production or deficiency of parathyroid hormone (PTH). PTH plays a crucial role in regulating calcium, phosphorus, and vitamin D levels in the blood. This deficiency leads to low blood calcium and high phosphorus levels, disrupting the body's delicate balance of these essential minerals. While there's no cure or preventive diet for hypoparathyroidism, adopting a healthy eating plan and avoiding certain foods and drinks can significantly aid in managing the condition and balancing key nutrients.
Understanding Hypoparathyroidism
Under normal circumstances, interactions between PTH and active vitamin D, along with the dynamics of calcium and phosphorus absorption, renal tubular handling of those ions, and skeletal responsiveness, help maintain calcium homeostasis and skeletal health. In the absence of PTH, the gastrointestinal tract, kidneys, and skeleton are all affected, leading to hypocalcemia, hyperphosphatemia, reduced bone remodeling, and an inability to conserve filtered calcium.
Dietary Strategies for Managing Hypoparathyroidism
Pharmacological therapy for the management of hypoPT can be supplemented by non-pharmacological intervention, primarily alterations to diet to increase intake of foods rich in calcium and vitamin D, and limit intake of foods rich in phosphorus.
Foods to Limit or Avoid
Foods You Are Allergic To: Allergic reactions to food can increase inflammation, potentially disrupting hormone levels and thyroid function. Some studies suggest individuals with hypoparathyroidism may have or develop food sensitivities, including celiac disease, a reaction to gluten found in wheat, barley, and rye. Consider allergy testing and avoid identified allergens.
Carbonated Drinks: Carbonated beverages like soda, sparkling water (seltzer), and some energy drinks often contain high levels of phosphates. Phosphates can leach calcium from bones, exacerbating the calcium deficiency in hypoparathyroidism. It's important to stay well-hydrated, so opt for at least 6-8 glasses of non-carbonated water a day.
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Salty Foods: High salt intake can decrease calcium absorption. When you consume a lot of salt, more blood calcium is flushed out of your body through your pee. This can also lead to kidney calcification and stone formation. To help your body keep as much bone-strengthening calcium as possible, watch the amount of salt that you use when cooking and the sodium in the food you eat by reading nutritional labels on food packaging.
Refined Sugar and Carbs: Limiting refined sugars and carbohydrates, commonly found in white breads, pastas, and desserts, is advisable. These foods often contain phosphorus-based food additives used in processed foods. High blood phosphorus levels are linked to an increased risk of heart disease. Refined foods are loaded with sugar and are bad for overall health because they reduce the amount of calcium your body can absorb (and lower your vitamin D levels) and increase the amount of calcium that is flushed from the body through your pee.
Red Meat and Hard Cheeses: With hypoparathyroidism, your levels of phosphorus tend to be high, so it’s best to limit foods that are high in this mineral. Red meat is high in phosphorus, so try to get protein from plant-based sources, seeds or nuts, tofu, and beans. Hard cheeses, some forms of dairy, bread, rice, and oats are also high in phosphates.
Foods That Block the Body From Absorbing Calcium: Some foods have natural compounds that make it harder for your body to absorb calcium when they are eaten at the same time. These compounds can be found in spinach, potatoes and sweet potatoes, beets, beans, raspberries, tea, nuts, and seeds. You don’t need to avoid these foods altogether, just try not to eat them with foods that are high in calcium, like milk and other dairy products.
Coffee, Alcohol, and Smoking: Each of these can negatively impact your health in a lot of ways.
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Foods High in Phosphorus: Foods with a high phosphorus content include meat, milk, hard cheeses, whole grains, dried peas, beans, nuts, and chocolate.
Foods to Include
- Foods Fortified with Calcium: Foods fortified with calcium are preferred such as soy milk or nut milk drinks with calcium supplementation.
- Foods Rich in Vitamin D: Foods rich in vitamin D include salmon (and other oil-rich fish), shrimp, and milk with added vitamin D.
- Dietary sources of magnesium: Dietary sources of magnesium include almonds, soybean, seeds, wheat germ, wheat bran, millet, dark green vegetables, fruit, and seafood.
Important Considerations for Calcium Intake
Care must be taken with dietary items that are rich in both calcium and phosphorus, such as dairy products. Dairy products are an important dietary source of calcium because of their high calcium content and absorbability. They provide more calcium, protein, magnesium, potassium, zinc, and phosphorus per calorie than any other usual food found in the adult diet. Furthermore, dairy products are rich in aromatic amino acids, which stimulate hepatic production of IGF-1. When ingested during a protein-containing meal, calcium is better absorbed with less variability. To avoid substantial increases in postprandial urinary calcium excretion, calcium intake should be evenly distributed during the day.
Medical Management of Hypoparathyroidism
Diagnosis
To find out if you have hypoparathyroidism, your healthcare professional may start by asking you about your medical history. You're also given a physical exam. The level of magnesium in your blood also might be checked. A low level of magnesium may cause a low blood-calcium level. Urine test: Parathyroid hormones act on the kidneys to prevent too much calcium from going into in the urine. A urine test can tell whether your body is getting rid of too much calcium. Other tests: Your healthcare professional may suggest more tests.
Treatment
Conventional management of hypoparathyroidism has focused upon maintaining the serum calcium with oral calcium and active vitamin D, often requiring high doses and giving rise to concerns about long-term consequences including renal and brain calcifications. Replacement therapy with PTH has recently become available.
- Oral Calcium: These calcium supplements are taken by mouth as tablets, chews or liquid. They can raise calcium levels in your blood. Calcium carbonate and calcium citrate are the most common forms of oral calcium supplementation. Calcium carbonate contains 40% elemental calcium, and calcium citrate contains 21% elemental calcium. Absorption of calcium carbonate is best if taken with meals and with acid present in the stomach, whereas calcium citrate is well absorbed without regard to meals and does not require gastric acid.
- Vitamin D: High amounts of vitamin D can help your body absorb calcium and get rid of phosphorus. Often, this vitamin D is a prescription supplement called calcitriol. Because PTH is an important facilitator of the renal conversion of 25-hydroxyvitmain D to 1,25-dihydroxyvitamin D (calcitriol), this active form of vitamin D is preferred for treatment of patients with hypoparathyroidism. The initial dose of calcitriol is typically 0.25 to 0.5 μg twice daily.
- Magnesium: Magnesium deficiency is associated with impaired secretion and action of PTH. In patients who present with symptomatic hypocalcemia requiring urgent iv calcium replacement therapy, the possible coexistence of hypomagnesemia should always be considered. If the serum magnesium concentration is low, 2 g (16 mEq) of magnesium sulfate should be infused as a 10% solution over 10 to 20 minutes, followed by 1 g (8 mEq) in 100 mL of infusate per hour.
- Thiazide diuretics: These medicines may be used if your calcium levels stay low even with treatment. They also might be used if the amount of calcium in your urine is very high.
- Parathyroid hormone replacement: A type of medicine that replaces parathyroid hormones, called Natpara, has been available to treat hypothyroidism. But that medicine is being phased out. A newer type of medicine that replaces parathyroid hormones has been tested in clinical trials.
- Calcium infusion: If you need symptom relief right away, you may receive calcium through a needle in a vein. This is called an intravenous (IV) infusion. Most often, it's done in the hospital. You'll likely also take vitamin D tablets by mouth. After you leave the hospital, you keep taking calcium and vitamin D tablets. Initially, iv calcium (1 to 2 g of calcium gluconate, equivalent to 90-180 mg elemental calcium, in 50 mL of 5% dextrose) can be infused over 10 to 20 minutes.
Monitoring
Your healthcare professional likely will do blood tests to check your calcium and phosphorus levels on a regular basis. At first, these tests probably will be weekly to monthly. In time, you may need blood tests just once or twice a year. Regular testing lets your care professional change the amount of calcium you take if your levels rise or fall. Because hypoparathyroidism most often is a long-lasting disorder, testing and treatment tends to be lifelong. Serum calcium (corrected for albumin), phosphorus, and creatinine concentrations should be measured weekly to monthly during dose adjustments, and twice annually once a stable regimen has been reached.
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Preparing for Your Appointment
You'll likely start by seeing your primary care professional. You might then be referred to a doctor called an endocrinologist, who treats hormone disorders.
What You Can Do
When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat for a certain number of hours the night before a test. Take a family member or friend with you to the appointment if you can.
- Your symptoms. Include any that don't seem related to the reason for your appointment.
- Key personal information.
- All medicines, vitamins, herbs and other supplements you take.
Questions to ask:
- What is the likely cause of my symptoms?
- Are there brochures or other printed material I can take?
Understanding the Broader Implications of Hypoparathyroidism
Symptoms of Hypoparathyroidism
Signs and symptoms of hypoparathyroidism include:
- Tingling or numbness in your lips, fingers and toes
- Muscle cramps and spasms
- “Brain fog” or confusion
- Abnormal heart rhythm
- Brittle nails and dry skin
- Cataracts
- Weak tooth enamel (in children)
In most cases, hypoparathyroidism progresses gradually, and symptoms can be mild. Many people have symptoms for years before they get a diagnosis.
Causes of Hypoparathyroidism
Causes of hypoparathyroidism include:
- Damage to your parathyroid glands: About 75% of cases are caused by accidental damage to the parathyroid glands during neck or thyroid surgery. This usually happens soon after surgery, but it can also occur many years later. In rare cases, radiation therapy can damage your parathyroid glands.
- Certain genetic conditions: Less than 10% of cases are genetic. The most common is DiGeorge syndrome, where babies are born without parathyroid glands, leading to lifelong low calcium. About 60% of children with hypoparathyroidism have DiGeorge syndrome.
- Certain autoimmune diseases: Certain diseases cause your immune system to attack your parathyroid glands.
- Low levels of magnesium: Low magnesium can cause the parathyroid glands to stop making or releasing enough PTH, leading to low calcium levels.
Risk factors
Risk factors for hypoparathyroidism include:
- Having recent neck or thyroid surgery
- Having a family history of parathyroid conditions
- Having an autoimmune disease that affects your endocrine system
- Having radiation therapy for head or neck cancer
Both adults and children can get hypoparathyroidism. Adults are more likely to get hypoparathyroidism from accidental damage to their parathyroid glands during surgery. Children are more likely to have hypoparathyroidism due to a genetic condition.
Complications of Hypoparathyroidism
Long-term complications of hypoparathyroidism can include:
- Issues with kidney function
- Kidney stones
- Calcium deposits in your brain
For children, complications from hypoparathyroidism can include:
- Slow growth
- Dental issues
- Developmental delays
- Bone problems
Complications of a sudden drop in calcium levels include seizures and larynx spasms. These can be dangerous.
Managing Acute Hypocalcemia
In hypoparathyroidism, hypocalcemia can occur acutely and become a true medical emergency. Hypocalcemia is defined as an ionized serum calcium (Ca2+) concentration that falls below the lower limit of the normal range. The treatment of hypocalcemia in hypoparathyroidism is influenced not only by the actual calcium concentration but also by any associated symptoms. When clinical circumstances dictate urgent treatment, iv Ca2+ salts are used. The goals of iv calcium therapy are to control symptoms, reverse signs (eg, prolonged QT interval), and restore the serum calcium level to the lower end of the normal range.
General Instructions
Take over-the-counter and prescription medicines only as told by your health care provider. Keep all follow-up visits. These symptoms may be an emergency. Get help right away. Do not wait to see if the symptoms will go away.
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