Clinical Presentation of Hypoparathyroidism

Hypoparathyroidism is a rare disorder that most commonly presents early after thyroid, parathyroid, or laryngeal surgery. The disorder can also present months and even years after the causative surgical procedure. Therefore, the astute clinician must be aware of the past surgical history in any patient who presents with reduced serum calcium levels and inappropriately normal or frankly low PTH levels with or without clinical manifestations of hypocalcemia. Variations in the severity of the abnormal mineral balance account, at least in part, for the nature and extent of the clinical presentation. Mildly low serum calcium may go undetected for years and produce little to no clinical complaints. Severely low and rapid falls in serum calcium tend to present with neuromuscular, sensory, and central nervous system complaints and need to be diagnosed and treated rapidly. The clinician should look for any of the many signs and symptoms of nonsurgical forms of hypoparathyroidism when the biochemical diagnosis is clear, but there is no history of prior procedure. To make the correct diagnosis, careful family history and possibly family screening are needed, as well as a thorough physical examination and assessment. In many cases, genetic testing will be needed to come to a definitive diagnosis.