Hypoparathyroidism in Emergency Medicine Workup

Updated: Aug 05, 2015
  • Author: Agnieszka Gliwa, MD; Chief Editor: Erik D Schraga, MD  more...
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Workup

Laboratory Studies

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  • The diagnosis of hypoparathyroidism is supported by hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels in the absence of renal failure or intestinal malabsorption.
  • Both total and ionized calcium are decreased. Normal total serum calcium levels range from 9-10.5 mg/dL (2.2-2.6 mmol/L). Normal ionized calcium levels are 4.5-5.6 mg/dL (1.1-1.4 mmol/L).
  • Serum magnesium level can be low, high, or normal.
  • Transient symptomatic hypocalcemia can occur immediately after thyroid surgery; normal PTH levels 3 hours after surgery and a normal serum calcium level on the postoperative day one rules out persistent hypoparathyroidism. [37]
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Imaging Studies

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  • Radiography: Bone density is increased [38] ; tooth enamel and root abnormalities have been described. [39] Ossification of the paravertebral ligaments is frequently observed. [40]
  • CT scan: Calcification of subcortical nuclei, dentate nucleus, [41] and basal ganglia [42] can occur.
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Other Tests

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  • ECG may show prolonged QT interval [43] , bradycardia, or rarely ST-segment elevations. [16]
  • For D-xylose absorption test, the results are usually normal. [44]
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Procedures

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  • Slit lamp examination for cataracts [24]
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