Causes of Hypoparathyroidism

• Hypoparathyroidism
  –Often occurs after thyroidectomy or parathyoidectomy
  –Infiltrative diseases of the parathyroid gland (e.g., hemochromatosis, Wilson's disease, sarcoidosis, tuberculosis)
  –Pseudohypoparathyroidism (parathyroid hormone resistance)
  –Idiopathic (autoimmune)

• Medications (e.g., diuretics, heparin, foscarnet, cimetidine, glucagon, phosphates, aminoglycosides, theophylline, cisplatin)
• Vitamin D deficiency
  –Poor oral intake and/or absent sun exposure
  –Malabsorption
  –Hepatic and/or renal failure
  –Anticonvulsant use
• Pancreatitis
• Alkalosis (especially respiratory alkalosis)
• Sepsis
• Shock
• Burns
• Magnesium deficiency (often seen in alcoholism)
• Hyperphosphatemia
• Alcoholism (may directly suppress PTH and/or deplete magnesium)
• Postoperative (usually transient)
• Post-blood transfusion
• Malignancy
  –Medullary carcinoma of the thyroid
  –Osteoblastic metastases
• Familial hypocalcemia
• DiGeorge's syndrome (congenital absence of the parathyroid glands)
• Polyglandular autoimmune syndrome, type I (hypoparathyroidism, adrenal insufficiency, and mucocutaneous candidiasis)
• Rickets

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hypocalcemia: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Hypoparathyroidism
  –Congenital: Transient neonatal vs heritable forms
  –Acquired: Autoimmune, postsurgical, radioablation, infiltrative
  –DiGeorge Syndrome
  –Polyglandular autoimmune disease type 1 (Blizzard syndrome)
  –Pseudohypoparathyroidism (PHP) or PTH resistance
        –PHP type IA (Albright dereditary osteodystrophy)
        –PHP type IB, type II

• Vitamin D deficiency
  –Nutritional deprivation
        –Most common cause of rickets
        –Seen in breast-fed and black children
  –Malabsorption/steatorrhea/liver disease
  –1-αhydroxylase deficiency
  –Chronic renal disease

• Calcium deficiency
  –Nutritional deprivation
  –Malabsorption
  –Hypercalciuria
• Hypomagnesemia
  –Impairs secretion of, and end-organ responsiveness to, PTH
  –Inherited forms
  –Intestinal losses
  –Renal wasting: RTA, drugs
• Hyperphosphatemia
• Hypoproteinemia
  –Total calcium is a measure of calcium bound to albumin
• Drugs
  –Loop diuretics (furosemide) promote renal calcium excretion
  –Anticonvulsants interfere with GI vitamin D absorption
  –Antacids impair GI calcium absorption
  –Antineoplastic agents
  –Citrated blood products
• Critical illness
  –Rhabdomyolysis
  –Toxic shock syndrome
  –Pancreatitis
• Organic acidemia
• Infant of a diabetic mother

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Chvostek's sign: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Hypocalcemia.

The degree of muscle spasm elicited reflects the patient's serum calcium level. Initially, hypocalcemia produces paresthesia in the fingers, toes, and circumoral area that progresses to muscle tension and carpopedal spasms. The patient may also complain of muscle weakness, fatigue, and palpitations. Muscle twitching, hyperactive deep tendon reflexes, choreiform movements, and muscle cramps may also occur. The patient with chronic hypocalcemia may have mental status changes; diplopia; difficulty swallowing; abdominal cramps; dry, scaly skin; brittle nails; and thin, patchy scalp and eyebrow hair.

Other causes

Blood transfusion.

A massive transfusion can lower serum calcium levels and allow Chvostek's sign to be elicited.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Thyroid enlargement: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Hypothyroidism

Hypothyroidism is most prevalent in women and usually results from a dysfunction of the thyroid gland, which may be due to surgery, irradiation therapy, chronic autoimmune thyroiditis (Hashimoto’s disease), or inflammatory conditions, such as amyloidosis and sarcoidosis. Besides an enlarged thyroid, signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

Iodine deficiency

A goiter may result from a lack of iodine in the diet. If the goiter arises from a deficiency of iodine in the food or water of a particular area, it’s called an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.

Thyroiditis

Thyroiditis, an inflammation of the thyroid gland, may be classified as acute or subacute. It may be due to bacterial or viral infections, in which case associated features include fever and thyroid tenderness. The most prevalent cause of spontaneous hypothyroidism, however, is an autoimmune reaction, as occurs in Hashimoto’s thyroiditis. Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.

Thyrotoxicosis

Overproduction of thyroid hormone causes thyrotoxicosis. The most common form is Graves’disease, which may result from genetic or immunologic factors. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors

An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.

Other causes

Goitrogens

Goitrogens are drugs — such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid — and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Hypoparathyroidism: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Hypoparathyroidism may be acute or chronic and is classified as idiopathic or acquired. The acquired form may also be reversible. Idiopathic hypoparathyroidism may result from an autoimmune genetic disorder or the congenital absence of the parathyroid glands. Acquired hypoparathyroidism commonly results from accidental removal of or injury to one or more parathyroid glands during thyroidectomy or other neck surgery; rarely it results from massive thyroid irradiation. It may also result from ischemic infarction of the parathyroids during surgery or from hemochromatosis, sarcoidosis, amyloidosis, tuberculosis, neoplasms, or trauma. An acquired, reversible hypoparathyroidism may result from hypomagnesemia-induced impairment of hormone synthesis, from suppression of normal gland function due to hypercalcemia, or from delayed maturation of parathyroid function. (See What happens in acute hypoparathyroidism.)

PTH isn’t regulated by the pituitary or hypothalamus. It normally maintains blood calcium levels by increasing bone resorption and GI absorption of calcium. It also maintains an inverse relationship between serum calcium and phosphate levels by inhibiting phosphate reabsorption in the renal tubules. Abnormal PTH production disrupts this balance. The incidence is 4 out of 100,000 people. Incidence of the idiopathic and reversible forms is highest in children; that of the irreversible acquired form, in older patients who have undergone surgery for hyperthyroidism or other head and neck conditions.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Chvostek's sign: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Hypocalcemia

The degree of muscle spasm elicited reflects the patient’s serum calcium level. Initially, hypocalcemia produces paresthesia in the fingers, toes, and circumoral area that progresses to muscle tension and carpopedal spasms. The patient may also complain of muscle weakness, fatigue, and palpitations. Muscle twitching, hyperactive deep tendon reflexes, choreiform movements, and muscle cramps may also occur. The patient with chronic hypocalcemia may have mental status changes; diplopia; difficulty swallowing; abdominal cramps; dry, scaly skin; brittle nails; and thin, patchy scalp and eyebrow hair.

Other causes

Blood transfusion

A massive transfusion can lower serum calcium levels and allow Chvostek’s sign to be elicited.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Thyroid enlargement: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Hypothyroidism

This disorder, which is most prevalent in women, usually results from a dysfunction of the thyroid gland caused by surgery, irradiation therapy, chronic autoimmune thyroiditis (Hashimoto’s disease), or inflammatory conditions, such as amyloidosis and sarcoidosis. Besides an enlarged thyroid, signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

Iodine deficiency

A goiter may result from a lack of iodine in the diet. A goiter that arises from a deficiency of iodine in the food or water of a particular area is called an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.

Thyroiditis

Thyroiditis, an inflammation of the thyroid gland, may be classified as acute or subacute. It may be due to bacterial or viral infections, in which case associated features include fever and thyroid tenderness. The most prevalent cause of spontaneous hypothyroidism, however, is an autoimmune reaction, as occurs in Hashimoto’s thyroiditis. Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.

Thyrotoxicosis

Overproduction of thyroid hormone causes thyrotoxicosis. The most common form is Graves’disease, which may result from genetic or immunologic factors. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; diaphoresis; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors

An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.

Other causes

Goitrogens

Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs containing goitrogens include lithium, sulfonamides, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Neck Mass/Thyroid Enlargement: Differential Overview
(Field Guide to Bedside Diagnosis)

Neck Mass

❑ Inflammatory lymphadenopathy

❑ Parotid swelling/tumor

❑ Laryngeal cancer

❑ Intramuscular hematoma

❑ Lymphoma

❑ Nasopharyngeal carcinoma

❑ Branchial cleft cyst

❑ Thyroglossal duct cyst

❑ Supraclavicular adenopathy

❑ Aortic aneurysm

❑ Carotid aneurysm

❑ Ludwig angina

❑ Pharyngeal pouch

❑ Carotid body tumor

Thyroid Enlargement

❑ Simple goiter

❑ Hashimoto thyroiditis

❑ Grave disease

❑ Drugs

❑ Subacute thyroiditis

❑ Thyroid cancer

❑ Infiltrative disease

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Hypoparathyroidism: Causes
(Handbook of Diseases)

Hypoparathyroidism may be acute or chronic and is classified as idiopathic or acquired:

❑ Idiopathic hypoparathyroidism may result from an autoimmune genetic disorder or the congenital absence of the parathyroid glands.

❑ Acquired hypoparathyroidism commonly results from accidental removal of or injury to the parathyroid glands during thyroidectomy or other neck surgery or, rarely, from massive neck irradiation. It may also result from ischemic infarction of the parathyroid glands during surgery or from hemochromatosis, sarcoidosis, amyloidosis, tuberculosis, neoplasms, or trauma.

❑ Acquired, reversible hypoparathyroidism may result from hypomagnesemia-induced impairment of hormone synthesis and release, from suppression of normal gland function due to hypercalcemia, or from delayed maturation of parathyroid function.

PTH isn’t regulated by the pituitary or hypothalamus. It normally maintains blood calcium levels by increasing bone resorption and GI absorption of calcium. It also maintains an inverse relationship between serum calcium and phosphate levels by inhibiting phosphate reabsorption in the renal tubules. Abnormal PTH production disrupts this balance. Incidence of the idiopathic and reversible forms is highest in children; incidence of the irreversible acquired form is highest in older patients who have undergone surgery for hyperthyroidism or other head and neck conditions.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Chvostek's sign: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Hypocalcemia

Chvostek’s sign may indicate hypocalcemia. The degree of muscle spasm elicited reflects the patient’s serum calcium level. Initially, hypocalcemia produces paresthesia in the fingers, toes, and circumoral area that progresses to muscle tension and carpopedal spasms. The patient may also complain of muscle weakness, fatigue, and palpitations. Muscle twitching, hyperactive deep tendon reflexes, choreiform movements, and muscle cramps may also occur. The patient with chronic hypocalcemia may have mental status changes; diplopia; difficulty swallowing; abdominal cramps; dry, scaly skin; brittle nails; and thin, patchy scalp and eyebrow hair.

Other causes

Treatments

A massive blood transfusion can lower serum calcium levels and allow Chvostek’s sign to be elicited.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Thyroid enlargement: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Hypothyroidism

Besides an enlarged thyroid, signs and symptoms of hypothyroidism include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

CULTURAL CUE:Goiters are common in areas of the world that are deficient in iodine, such as Asia, Latin America, Africa, and parts of Europe.

Thyroiditis

Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement. In subacute granulomatous thyroiditis, moderate thyroid enlargement may follow an upper respiratory infection or a sore throat. The thyroid may be painful and tender. Dysphagia may also occur.

Thyrotoxicosis

One of the classic features of thyrotoxicosis is an enlarged thyroid gland. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors

An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Other causes

Goitrogens

Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs include lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Chvostek's sign: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Hypocalcemia.The degree of muscle spasm elicited reflects the patient's serum calcium level. Initially, hypocalcemia produces paresthesia in the fingers, toes, and circumoral area that progresses to muscle tension and carpopedal spasms. The patient may also complain of muscle weakness, fatigue, and palpitations. Muscle twitching, hyperactive deep tendon reflexes, choreiform movements, and muscle cramps may also occur. The patient with chronic hypocalcemia may have mental status changes; diplopia; difficulty swallowing; abdominal cramps; dry, scaly skin; brittle nails; and thin, patchy scalp and eyebrow hair.

Other causes

Blood transfusion.A massive blood transfusion can lower serum calciumlevels and allow Chvostek's sign to be elicited.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Thyroid enlargement: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Hypothyroidism.Hypothyroidism causes an enlarged thyroid. Additional signs and symptoms include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.

Iodine deficiency.A deficiency of iodine in the food or water of a particular area may cause an endemic goiter. Associated signs and symptoms of an endemic goiter include dysphagia, dyspnea, and tracheal deviation. This condition is uncommon in developed countries with iodized salt.

Thyroiditis.Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement.

Thyrotoxicosis.Signs and symptoms of thyrotoxicosis include an enlarged thyroid, nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.

Tumors.An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.

Thyroid tissue contained in ovarian dermoid tumors can function autonomously or in combination with thyrotoxicosis. Pituitary tumors that secrete thyroid-stimulating hormone (TSH), a rare type, are the only cause of normal or high TSH levels in association with thyrotoxicosis. Finally, high levels of human chorionic gonadotropin, as seen in trophoblastic tumors and pregnant women, can cause thyrotoxicosis.

Other causes

Goitrogens.Goitrogens are drugs—such as lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid—and substances in foods that decrease thyroxine production. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

 » Next page: Symptoms of Hypoparathyroidism

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