What Is Hypoparathyroidism?

Written by Martha Anne Tudor
Medically Reviewed by Shruthi N, MD on May 25, 2025
8 min read

Hypoparathyroidism is a rare and usually lifelong condition that causes low levels of calcium (hypocalcemia) and high levels of phosphorus in your blood. It's treatable and sometimes temporary. It's when your body doesn't have enough parathyroid hormone (PTH). That's a hormone made in four pea-sized lobes in your neck called parathyroid glands.

If your calcium gets too low, PTH triggers the release of calcium from your bones. It also raises the amount of calcium your body absorbs from your kidneys and intestine. Your body uses calcium to keep your nerves, muscles, and heart working. Without PTH, the lower levels of calcium can cause serious muscle spasms, tingling, heart problems, or seizures.

This condition affects fewer than 200,000 adults and children in the U.S. It affects equal numbers of males and females.

Hypoparathyroidism vs. hypothyroidism

Your parathyroid glands use PTH to balance calcium, while your thyroid gland makes thyroid hormone to control metabolism, body temperature, and energy levels. Hypothyroidism happens when your thyroid stops working, also called an underactive thyroid.

More than 75% of adult hypoparathyroidism cases are caused by damage to your parathyroid glands. That can happen accidentally during neck or thyroid surgery. In rare cases, this damage can result from radiation therapy. Hypothyroidism usually happens right after your parathyroid glands are injured, but it might take decades to develop.

Children with this condition are more likely to have it from a genetic condition called DiGeorge Syndrome.

Other causes include:

  • Certain autoimmune diseases, such as Addison's disease or pernicious anemia 
  • Infiltrative disorders (where abnormal substances or cells build up in tissues or organs), such as Wilson's disease and hemochromatosis
  • Low levels of magnesium

Hypoparathyroidism risk factors

The most common risk factors are:

  • Recent neck or thyroid surgery
  • A family history of parathyroid conditions
  • Autoimmune diseases that affect your endocrine system

Hypoparathyroidism symptoms can include:

  • Tingling or burning in your fingertips, toes, and lips
  • Muscle aches or cramps in your legs, feet, stomach, and face
  • Twitching or spasms of muscles around your mouth, hands, arms, and throat
  • Fatigue or weakness

Less common symptoms are:

  • Painful menstrual periods
  • Patchy hair loss
  • Dry, coarse skin
  • Brittle nails
  • Depression
  • Anxiety

Your doctor will ask about your medical history and do a physical exam. They may take samples of your blood and pee to run tests.

Blood tests

These may check for:

  • Low calcium
  • Low parathyroid hormone
  • High phosphorus

Your doctor might also test the level of magnesium in your blood.

Urine (pee) test

Your doctor may order a 24-hour urine test. Its results can tell them if your body is getting rid of too much calcium. That may indicate you have hypoparathyroidism, as your parathyroid hormone helps keep your kidneys from having too much calcium in your pee.

Other tests

Your doctor may do other tests to check for serious side effects of hypoparathyroidism. They may include:

  • EKG or ECG to see if your heart rhythm is normal
  • CT scan to see if there are calcium deposits on your brain
  • What caused my hypoparathyroidism?
  • Do I need any more tests?
  • How often will I need to see a doctor?
  • What kind of treatments can help? Which do you recommend?
  • How can I keep my calcium levels normal?
  • What kind of lifestyle changes do I need to make?
  • Will it ever go away?
  • Can my children get hypoparathyroidism?
  • If your child has the disease, ask their doctor how you can make sure they get the nutrients they need to grow.

The goal of treatment for hypoparathyroidism is to minimize your symptoms and correct the amount of calcium and minerals in your body.

Your treatment plan may include:

  • Calcium and vitamin D supplements. You'll likely need these for the rest of your life. It's the go-to treatment option for hypoparathyroidism. Your body needs vitamin D to absorb and use calcium, so you need to take both supplements.

    Magnesium supplement. You may need this if your magnesium is low and you have symptoms of hypoparathyroidism.

  • Thiazide diuretics. If your calcium levels are still low after taking supplements, you may need these. You might also need them if there's a lot of calcium in your pee.

    High-calcium and low-phosphorus diet. With hypoparathyroidism, you won't get enough calcium from diet alone. But your doctor may suggest a diet high in calcium and low in phosphorus.

    A medicine that replaced parathyroid hormones, called Natpara, was used to treat hypothyroidism before it was discontinued in late 2024. The drug's maker, Takeda, cited unresolved supply issues. A new medicine for replacing parathyroid hormones has been tested in clinical trials. But it's not yet approved in the U.S.

Along with hypoparathyroidism treatment, these lifestyle changes may help boost your well-being. 

Drink plenty of water. This helps keep your muscles and body hydrated. It also helps balance calcium levels. But bottled water can contain calcium, so check the label.

Exercise regularly. Physical activity keeps your bones strong and helps ward off fractures. Ask your doctor about what kinds of exercise (and how much) are right for you.

Pay attention to what you eat. Hypoparathyroidism can cause you to have too little calcium but too much phosphorus. So, try to track how much of these nutrients you eat each day. While a diet high in calcium and low in phosphorus may help, it's not likely to manage your hypoparathyroidism by itself. You'll still need supplements or other treatments.

Ask your doctor about foods high in calcium. These foods help boost calcium levels:

  • Dairy products such as milk or cheese (which also contain phosphorus)
  • Beans
  • Tofu
  • Nuts, especially almonds
  • Dark leafy greens
  • Broccoli
  • Fish with soft bones (such as canned salmon)

Some juices, breads, and cereals also have calcium added to them. 

Avoid foods high in phosphorus. It's also called phosphates or phosphoric acid in the ingredient list. These include:

  • Fizzy drinks
  • Processed foods
  • Red meat
  • Poultry
  • Fish
  • Dairy
  • Hard cheeses
  • Nuts
  • Whole grains such as rice, oats, and bread
  • Some vegetables

Some foods are high in both calcium and phosphorus, such as dairy. Ask your doctor or nutritionist to help you figure out what's right for you.

Stay in touch with your doctor. Hypoparathyroidism can affect your whole body, especially your kidneys and bones. Your doctor can keep an eye on these organs with regular blood tests and bone density scans (which measure your bone thickness).

See your dentist regularly. Too little calcium can hurt your teeth. You can get more cavities or other dental problems.

Getting enough calcium and vitamin D, or PTH replacement, can help keep your hypoparathyroidism under control. See your doctor regularly, they'll monitor your condition and do blood tests. Without treatment, hypoparathyroidism may be life-threatening.

Hypoparathyroidism, if not managed well, can lead to a variety of mild to severe changes over time. These changes can affect multiple systems in your body. At first, your symptoms may be mild. But if your condition isn't treated, long-term effects can include:

Neurological. Calcium deposits can form in your brain, which can cause seizures, cognitive issues, and movement disorders. 

Cardiovascular. You may have problems with your heart rhythm and even experience heart failure. 

Renal. You might have kidney issues, including stones, renal insufficiency, and chronic kidney disease. 

Ophthalmological. You may have clouded vision fromcataracts. 

Musculoskeletal. These issues can affect children with hypoparathyroidism, affecting their growth, dental health, and bone structure. 

Skin. You might have dry, scaly skin and brittle nails.

Some of these issues aren't reversible, but it's never too late to get help for hypoparathyroidism. 

Along with these physical issues, your quality of life may also worsen. That can be due to ongoing pain, fatigue, and mobility issues. But there's help available. Talk to your doctor or mental health therapist about ways to manage your symptoms and boost your emotional and psychological health with hypoparathyroidism.

For more information, visit the web site of the Hypoparathyroidism Association. You can also check out the National Organization for Rare Disorders (NORD) or ParathyroidUK.

Hypoparathyroidism is a rare and usually lifelong condition that causes low levels of calcium (hypocalcemia) and high levels of phosphorus in your blood. It can affect children and adults. It's most commonly caused in adults by injury to your parathyroid glands. In children, it's usually caused by a genetic disease. It's treatable and sometimes temporary.

Can you gain weight with hypoparathyroidism?

Yes. Early on, limited physical activity can lead to weight gain. But in later stages, abdominal and digestive issues can lead to weight loss.

What organs does hypoparathyroidism affect?

Your kidneys, bones, nerves, and heart may be affected. This condition can also affect your digestive system and your muscles.

At what age does hypoparathyroidism start?

It can start at any age, from infancy to adulthood. The type of hypoparathyroidism that's passed down through your family usually shows up before you're 10.

Which autoimmune disease is associated with hypoparathyroidism?

It can be caused by autoimmune diseases such as Addison's disease and pernicious anemia. 

What happens if hypoparathyroidism is left untreated?

It can lead toseizures, larynx spasms (which can make it difficult to breathe), muscle spasms, heart problems, and kidney damage. In children, it can lead to problems with dental development, stunt their growth, and delay their mental development. 

Can you reverse hypoparathyroidism?

Your symptoms can usually be managed. But if you have cataracts, brain calcifications, changes in the shape of your bones, or dental changes from hypoparathyroidism, they can't be reversed.

What are the long-term effects of hypoparathyroidism?

For adults, long-term issues can include calcium deposits on your brain, cataracts, kidney stones, and poor kidney function. For children, long-term impact can include poor growth, dental issues, and slow mental development.

What's the drug of choice for hypoparathyroidism?

The most common treatments are vitamin D and calcium supplements. There was a drug, called Natpara, used to treat hypoparathyroidism by replacing parathyroid hormones, but it was discontinued in late 2024. A new medicine to replace parathyroid hormones has been tested in clinical trials. But it's not yet approved in the U.S..