eMedicine Specialties > Endocrinology > Parathyroid Gland

Hypoparathyroidism: Treatment & Medication

Author: J Michael Gonzalez-Campoy, MD, PhD, FACE, Medical Director and CEO, MN Center for Obesity, Metabolism, and Endocrinology
Contributor Information and Disclosures

Updated: Jul 17, 2009

Treatment

Medical Care

  • PTH is commercially available for use in the treatment of osteoporosis. Its use for patients with hypoparathyroidism is not approved by the Food and Drug Administration.
  • Currently, treatment of patients with hypoparathyroidism involves correcting the hypocalcemia by administering calcium and vitamin D.6

Surgical Care

  • Patients undergoing parathyroidectomy for parathyroid hyperplasia are at high risk of developing permanent primary hypoparathyroidism.
  • Patients may be treated with an autotransplant of a segment of parathyroid gland to prevent hypoparathyroidism.3 This autotransplant is usually placed subcutaneously in the forearm or in the neck.
  • If the autotransplantation fails, patients receive the same treatment that is administered to other patients with hypoparathyroidism.

Consultations

An endocrinologist should be involved in the care of all patients who have primary hypoparathyroidism or who are at risk of developing it.

Diet

A diet rich in calcium content (ie, emphasizing dairy products) is recommended for patients with primary hypoparathyroidism.

Activity

Patients with symptomatic hypocalcemia develop tetany. Otherwise, no restriction in activity for these patients is necessary.

Medication

Calcium and vitamin D are the mainstays of treatment.

Calcium salts

Without PTH, the ionized calcium levels in the plasma drop. Bone becomes an inefficient source of calcium for plasma, and kidneys waste calcium. Calcium helps maintain the ionized calcium level close to the reference range.


Calcium carbonate (Tums Extra Strength, Cal-Plus, Caltrate, Os-Cal 500)

Moderates nerve and muscle performance and facilitates normal cardiac function. Many commercially available preparations exist. Titrate total daily dose of elemental calcium to minimize the daily dose of vitamin D and to keep patients asymptomatic. Ionized calcium is absorbed best in an acidic environment; 400 mg elemental calcium equals 1 g calcium carbonate.

Adult

1-2 g/d elemental calcium PO
2.5-5 g/d calcium carbonate PO

Pediatric

Administer as in adults

May decrease effects of tetracyclines, atenolol, salicylates, iron salts, and fluoroquinolones; IV administration antagonizes effects of verapamil; large intakes of dietary fiber may decrease calcium absorption and levels

Documented hypersensitivity; renal calculi; hypercalcemia; hypophosphatemia; renal or cardiac disease; patients with digitalis toxicity

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Nephrocalcinosis and nephrolithiasis are potential complications of therapy; caution in patients who are digitalized and patients with respiratory failure or acidosis; in absence of PTH, may precipitate in urinary tract


Calcium citrate (Citracal, Cal-Citrate 250)

Moderates nerve and muscle performance and facilitates normal cardiac function; 210 mg of elemental calcium equals 1 g calcium citrate.

Adult

1-2 g/d elemental calcium PO
4.5-9 g/d calcium citrate PO

Pediatric

Administer as in adults

May decrease effects of tetracyclines, atenolol, salicylates, iron salts, and fluoroquinolones; IV administration antagonizes effects of verapamil; large intakes of dietary fiber may decrease calcium absorption and levels

Documented hypersensitivity; renal calculi; hypophosphatemia; hypercalcemia

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Pregnancy category D if dosage exceeds RDA; nephrocalcinosis and nephrolithiasis are potential complications of therapy; caution in patients who are digitalized and patients with respiratory failure or acidosis; may precipitate in urinary tract in absence of PTH; adequate dietary calcium is needed for clinical response; maintain adequate fluid intake; calcium-phosphate product (serum calcium times phosphorus) not to exceed 70; avoid use with renal function impairment and secondary hyperparathyroidism; avoid hypercalcemia


Calcium gluconate (Kalcinate)

Moderates nerve and muscle performance and facilitates normal cardiac function. Available for IV use. Infuse slowly over 5-10 min; 10 mL calcium gluconate contains approximately 90 mg elemental calcium; 1000 mg of calcium gluconate equals 90 mg elemental calcium.

Adult

90 mg elemental calcium (1 g calcium gluconate) IV over 5-10 min

Pediatric

Administer as in adults

May decrease bioavailability of tetracyclines, fluoroquinolones, iron salts, salicylates, atenolol, and sodium polystyrene sulfonate; IV calcium may antagonize verapamil effects; large intake of dietary fiber may decrease calcium absorption; IV calcium may increase quinidine and digitalis effects

Documented hypersensitivity; ventricular fibrillation during cardiac resuscitation; digitalis toxicity; renal or cardiac disease; hypercalcemia; renal calculi; hypophosphatemia

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Avoid rapid IV administration; caution in patients who are digitalized and patients with severe hyperphosphatemia; patients with respiratory failure or acidosis; avoid extravasation; may produce cardiac arrest; hypercalcemia may occur in renal failure; monitor serum calcium during early dosing period; nephrocalcinosis and renal lithiasis are potential adverse effects of chronic renal calcium loss

Vitamin D preparations

Vitamin D is synthesized by the kidneys, and the synthesis of 1,25-dihydroxy vitamin D is PTH dependent. In most patients with chronic hypoparathyroidism, treatment with the active vitamin D form is necessary.6


Ergocalciferol (Calciferol, Drisdol)

Stimulates absorption of calcium and phosphate from small intestine and promotes release of calcium from bone into blood.

Adult

50,000-100,000 U/d PO/IM

Pediatric

Administer as in adults

Colestipol, mineral oil, and cholestyramine may decrease absorption from small intestine; thiazide diuretics may increase effects

Documented hypersensitivity; hypercalcemia; malabsorption syndrome

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Pregnancy category D if dosage exceeds RDA; caution in patients with impaired renal function, renal stones, heart disease, or arteriosclerosis


Dihydrotachysterol (DHT, Hytakerol)

Synthetic analog of vitamin D. Stimulates calcium and phosphate absorption from small intestine and promotes secretion of calcium from bone to blood. Promotes renal tubule resorption of phosphate.

Adult

125-250 mcg/d PO

Pediatric

Administer as in adults

Colestipol, mineral oil, and cholestyramine may decrease absorption from the small intestine; thiazide diuretics may increase effects of vitamin D

Documented hypersensitivity; hypercalcemia

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Pregnancy category D if dosage exceeds RDA; caution in impaired renal function, renal stones, heart disease, or arteriosclerosis


Calcifediol (Calderol)

Promotes absorption of calcium and phosphorus in the small intestine. Promotes renal tubule resorption of phosphate. Increases rate of accretion and resorption in bone minerals.

Adult

50-220 mcg/d PO

Pediatric

Administer as in adults

Cholestyramine and colestipol decrease effects; thiazide diuretics increase effect

Documented hypersensitivity; hypercalcemia

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Pregnancy category A per expert analysis; pregnancy category C per manufacturer; pregnancy category D if dosage exceeds RDA; adequate dietary calcium needed for clinical response; maintain adequate fluid intake; calcium-phosphate product (serum calcium times phosphorus) not to exceed 70; avoid use with renal function impairment and secondary hyperparathyroidism; avoid hypercalcemia


Calcitriol (Rocaltrol, Calcijex)

Promotes absorption of calcium in intestines and retention at kidneys to increase calcium levels in serum. Decreases excessive serum phosphatase levels and parathyroid levels. Decreases bone resorption.

Adult

0.5-1 mcg/d PO

Pediatric

Administer as in adults

Cholestyramine and colestipol decrease effects; thiazide diuretics increase effects; magnesium-containing antacids have additive effects

Documented hypersensitivity; hypercalcemia; vitamin D toxicity; malabsorption syndrome

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Pregnancy category D if dosage exceeds RDA; adequate dietary calcium is needed for clinical response; maintain adequate fluid intake; calcium-phosphate product (serum calcium times phosphorus) not to exceed 70; avoid use with renal function impairment and secondary hyperparathyroidism; avoid hypercalcemia

More on Hypoparathyroidism

Overview: Hypoparathyroidism
Differential Diagnoses & Workup: Hypoparathyroidism
Treatment & Medication: Hypoparathyroidism
Follow-up: Hypoparathyroidism
References
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References

  1. Goswami R, Goel S, Tomar N, et al. Prevalence of clinical remission in patients with sporadic idiopathic hypoparathyroidism. Clin Endocrinol (Oxf). Jun 22 2009;[Medline].

  2. Rubin MR, Dempster DW, Zhou H, et al. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res. Dec 2008;23(12):2018-24. [Medline].

  3. Ebrahimi H, Edhouse P, Lundgren CI, et al. Does autoimmune thyroid disease affect parathyroid autotransplantation and survival?. ANZ J Surg. May 2009;79(5):383-5. [Medline].

  4. Brown EM. Anti-parathyroid and anti-calcium sensing receptor antibodies in autoimmune hypoparathyroidism. Endocrinol Metab Clin North Am. Jun 2009;38(2):437-45, x. [Medline].

  5. Goltzman D, Cole DEC. Hypoparathyroidism. In: Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Philadelphia, Pa: Lippincott-Raven; 1996:220-3.

  6. Cheung M. Drugs used in paediatric bone and calcium disorders. Endocr Dev. 2009;16:218-232. [Medline].

  7. Brown EM, Harris HW, Vassilev PM. The biology of the extracellular Ca2+-sensing receptor. In: Bilezikian JP, ed. Principles of Bone Biology. San Diego, Calif: Academic Press; 1996:243-62.

  8. Cole DEC, Hendy GN. Hypoparathyroidism and pseudohypoparathyroidism. Endotext.com. 2005, Available at. [Full Text].

  9. Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. Dec 21 2000;343(25):1863-75. [Medline].

  10. Thakker RV. Molecular basis of PTH underexpression. In: Bilezikian JP, et al, eds. Principles of Bone Biology. San Diego, Calif: Academic Press; 1996:837-51.

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Further Reading

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Keywords

hypoparathyroidism, parathyroid, PTH, hyperparathyroidism, hypocalcemia, parathyroid hormone, tetany, parathyroid glands, parathyroid gland, surgery parathyroid, parathyroid surgery, parathyroidectomy, hypoparathyroid, parathyroid hormone deficiency, PTH deficiency, primary hypoparathyroidism, inadequate PTH activity, secondary hypoparathyroidism, hypercalcemia

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Contributor Information and Disclosures

Author

J Michael Gonzalez-Campoy, MD, PhD, FACE, Medical Director and CEO, MN Center for Obesity, Metabolism, and Endocrinology
J Michael Gonzalez-Campoy, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Medical Association, and Minnesota Medical Association
Disclosure: Nothing to disclose.

Medical Editor

David S Schade, MD, Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center
David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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