Hypoparathyroidism: Recognizing Signs, Symptoms, and Etiologies

Welcome back to another HCPLive Peer Exchange series. In this episode titled "Hypoparathyroidism: Recognizing Signs, Symptoms, and Etiologies," moderator Dr. Natalie Cusano discusses hypoparathyroidism with Dr. Sara Lubitz, Dr. Dolores Shoback, Dr. Andrea Ferenczi, and Dr. Azarmindokht Khosravi.

Dr. Cusano opens the program by welcoming the panel and framing the discussion around hypoparathyroidism as a rare but complex, multisystem endocrine disorder. She invites Dr. Shoback to describe its hallmark signs and symptoms.

Dr. Shoback emphasizes that neurologic and neuromuscular symptoms are among the most prominent features, including tetany, painful muscle cramping, spasms, and paresthesias such as numbness around the mouth, fingertips, and toes. She also highlights significant cognitive burden, including brain fog, anxiety, and depression. In severe cases, patients may experience bronchospasm, laryngospasm, and seizures when calcium levels drop critically low. Long-term complications include cardiovascular effects on the heart and blood vessels, as well as renal complications such as kidney stones and progression to chronic kidney disease.

Dr. Cusano asks about the primary etiologies and why the condition may go unrecognized. Dr. Shoback notes that postsurgical hypoparathyroidism accounts for approximately 70–80% of cases, most commonly following thyroid surgery, neck dissection, or treatment for hyperparathyroidism. The remaining 20–25% represents a heterogeneous group including genetic etiologies, autoimmune causes, and idiopathic cases. She explains that underrecognition often occurs because patients are managed in silos by specialists—such as neurologists treating seizures—without a unifying diagnosis being established.

In the next episode, "Diagnosing Hypoparathyroidism and Establishing a Multisystem Baseline," Dr. Lubitz outlines the diagnostic criteria and common pitfalls in confirming hypoparathyroidism, and Dr. Khosravi explains how to systematically establish a multisystem baseline across the kidneys, skeleton, and neuropsychiatric systems.