Treatment.

Hypoparathyroidism was a life threatening disorder that often caused hypocalcemic tetany, seizures, and death before the introduction of vitamin D therapy back in the 1930s.

The treatment for HPTH should be managed by a specialist in Endocrinology or Nephrology.

The treatment is life long and the medication is the hormone Active vit. D (Rocaltrol/Etalpha). Extra magnesium and calcium are often given. It may also be evaluated if the calcium is very unstable to give a long acting vit. D.(Afi D2 Forte, Ergokalsiferol). If the calcium gets acutely low, calcium infusions should be given in an Intensive care unit. A diet low in phosphate is recommended.

The treatment is not without risks. If the calcium and phosphate level in the blood gets too high it might be secreted into the tissues.
The lack of PTH also may lead to excessive excretion of calcium in the urine. It is thus important that the blood calcium value is at the lower normal range. There are different opinions among professionals on regard to how much calcium supplementation that should be given. In the Nordic countries the advice is around 1000 mg calcium or none at all. A good advice might be to use a diet, which is rich in calcium.

Two studies are now conducted in America on the use of PTH hormone for Hypoparathyroidism. Up till now the study indicates that the PTH hormone reduces the great amount of calcium excreted in the urine and the skeleton becomes healthier (bone turnover is more normal). The studies also indicate a great improvement in the well being of the patients.

Follow up:
Cautions in the use of Rocaltrol/Etalpha (guidelines from the medical company): Serum calcium and -phosphate should be monitored twice a week initially. The patient should be informed on symptoms of hypocalcaemia and be instructed to contact a doctor if such symptoms occur. In periods of hypercalcaemia, serum calcium and -phosphate should be monitored daily. When the calcium levels are stabilised, serum calcium should be monitored every month. This should also be made on patients that have been on the treatment for a long time and seemingly are stabilised.

24-hour measurement of calcium and magnesium in the urine should be made yearly. The specialist will also consider measuring the D vitamins in the blood. PTH levels in the blood are also measured and are being compared to the calcium levels (normogram).

The specialist also considers a bone density test, tests of the kidney function and -ultrasound, x-rays and CT, inspection to exclude cataract. Weakness and pains in the body often require physiotherapy.