Parathyroid Hypofunction

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida

Introduction

Parathyroid hypofunction, medically known as hypoparathyroidism, is a rare endocrine disorder characterized by insufficient production of parathyroid hormone (PTH). PTH plays a vital role in maintaining calcium and phosphorus balance, along with activating vitamin D to support calcium absorption. When the parathyroid glands underproduce PTH, it can lead to hypocalcemia (low calcium) and hyperphosphatemia (high phosphorus)—both of which can disrupt neuromuscular function, cardiovascular health, and bone metabolism.

At Intercoastal Health, we take a functional medicine practitioner approach to understanding, diagnosing, and treating hypoparathyroidism. Our goal is to go beyond symptom management by identifying contributing factors, restoring mineral balance, and preventing long-term complications through personalized nutrition, supplementation, and lifestyle medicine.

What Is Hypoparathyroidism?

The parathyroid glands, four small structures located behind the thyroid, secrete PTH to regulate blood calcium and phosphorus levels. PTH works by:

• Promoting calcium release from bones into the bloodstream
• Enhancing calcium reabsorption in the kidneys
• Stimulating conversion of vitamin D to its active form (calcitriol) to increase intestinal calcium absorption
• Decreasing phosphorus reabsorption in the kidneys, promoting excretion

   

In hypoparathyroidism, this hormonal feedback system is impaired. The result is low serum calcium and elevated phosphate, leading to a wide range of neuromuscular, psychological, and systemic symptoms.

Symptoms and Clinical Presentation

The symptoms of parathyroid hypofunction primarily reflect neuromuscular irritability caused by hypocalcemia, though the condition may also affect skin, hair, teeth, and cardiovascular function.
Common Symptoms Include:

• Muscle cramps and spasms (tetany)
• Tingling or numbness in the lips, fingers, and toes (paresthesia)
• Fatigue, weakness, and exercise intolerance
• Anxiety, depression, and mood instability
• Dry skin, brittle nails, and hair thinning or loss
• Dental anomalies: Enamel hypoplasia, malformed teeth
• Convulsions or seizures in severe cases
• Cardiac arrhythmias, including prolonged QT interval on ECG

   

Functional Medicine Evaluation: Labs and Biomarkers

At Intercoastal Health, we assess clinical history, nutritional status, and laboratory biomarkers to accurately diagnose hypoparathyroidism and evaluate its impact on mineral metabolism.

Causes of Parathyroid Hypofunction

Identifying the underlying cause is essential to creating a sustainable and effective treatment plan. Hypoparathyroidism may be acquired, autoimmune, genetic, or secondary to nutrient deficiency.

• Post-Surgical Hypoparathyroidism: Occurs after thyroidectomy or neck surgery where glands are damaged or removed
• Autoimmune Hypoparathyroidism: Body forms antibodies against parathyroid tissue
• Genetic Disorders: Congenital absence of glands (DiGeorge syndrome) or calcium-sensing receptor mutations
• Radiation Therapy: Head and neck radiation can impair glandular function
• Magnesium Deficiency: Critical cofactor for PTH secretion; may arise from diuretics, GI losses, or alcoholism

   

Clinical Implications and Related Conditions

Without adequate treatment, chronic hypoparathyroidism can result in tissue calcification, disrupted bone remodeling, and long-term neurological and cardiovascular issues.

Functional Medicine Approach to Management

1. Calcium and Magnesium Repletion
   • Oral calcium citrate for superior absorption
   • Magnesium supplementation (glycinate or malate) to correct deficiency
   • IV calcium for acute severe hypocalcemia
2. Vitamin D Optimization
   • Active calcitriol plus D3 to support absorption
   • Maintain 25(OH)D between 40–60 ng/mL
   • Co-supplement vitamin K2 to prevent vascular calcification
3. Dietary Recommendations
   • Emphasize calcium- and magnesium-rich foods: leafy greens, nuts, seeds, fatty fish
   • Reduce phosphate-rich processed foods and soft drinks
   • Avoid high-oxalate foods that bind calcium
4. Lifestyle and Bone Health
   • Weight-bearing exercise for bone strength
   • Sun exposure for vitamin D synthesis
   • Stress management to support endocrine balance
   • Adequate hydration to prevent nephrocalcinosis
5. Hormone Replacement Therapy (HRT)
   • Consider recombinant PTH (Natpara) in refractory cases
   • Monitor bone turnover and urinary calcium

      

Monitoring and Long-Term Care

• Serum calcium, phosphorus, and magnesium every 3–6 months
• Annual urinary calcium to prevent hypercalciuria
• Periodic ECGs
• Bone density (DEXA) every 1–2 years
• Symptom and dietary review