Comprehensive Guide on Hypocalcemia: Causes, Symptoms, and Treatment

Treatment of hypocalcemia depends on the presence and severity of symptoms and the degree and etiology of hypocalcemia. Management of hypocalcemia can be divided into different categories below. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Hypocalcemia was defined as a calcium level of ≤7.6 mg/dl or symptoms of hypocalcemia any time after surgery.
Calcium is vital for many bodily functions, so this test is crucial for diagnosing hypocalcemia.
As in the PT, transcellular (active) Ca+2 transport in the TAL is enhanced by calcitonin and PTH.

Hypocalcemia and Surgery

Advances in intraoperative technology to optimize the vascularization of the parathyroid gland can help to predict postoperative hypoparathyroidism. Thyroidectomy is one of the most common surgeries with low morbidities 1, which is related to the skill and experience of the surgeon 2. Because thyroid surgery is performed in an area with a complex anatomy, nerves, glands and surrounding vessels are at risk of damage 3,4. Complications after thyroidectomy could be anatomic like recurrent laryngeal nerve injury, bilateral recurrent nerve paralysis, cervical hematoma and/or endocrine like hypoparathyroidism, myxedema and hypocalcemia 5,6. Unfortunately, for the patients who had mild hypocalcaemia, the prescribing rates of calcium replacement, as per the guidelines, decreased. However, only three patients in the repeat audit were found to have mild hypocalcaemia and so it is difficult to infer the impact of the QI project in this area.

Phenotypic variability is another problem with the diagnosis of AHO even among affected individuals in a kindred.
The patient can be observed in the hospital overnight, or, if reliable, compliant, and close by, they can be sent home with clear instructions on symptoms and when to call the doctor.
Hypocalcaemia can range in its severity from mild symptoms such as muscle spasms and cramps to serious and life-threatening sequelae including seizures, personality disturbances and prolonged QT intervals 6.
Multiple studies have described delayed onset of hypocalcemic symptoms, with an average interval between thyroid surgery and the onset of symptoms of 37–41 h (30, 31, 32).

Genetic and Age-Related Risk Factors

Another study found that the incidence ranged between 50% and 68%, particularly after total thyroidectomy 11.
More recently, the intact recombinant native 84-amino acid PTH molecule rhPTH(1-84) has been studied.
Calcitonin is released by the thyroid C cells in response to increased calcium levels.
Transcellular Ca+2 absorption occurs via two epithelial Ca+2 channels that belong to the transient receptor potential (TRP) superfamily and specifically to the vanilloid subfamily (TRPV) 5.

There is also a group with specific promoter DNA methylation defects which lead to a reduction in GNAS1 transcription due to the loss of methylation. Decreased synthesis of vitamin D in the skin is not uncommon and may be due to the lack of sun exposure due to excessive sunscreen usage, skin pigmentation, protective clothing, winter season, increased latitude or aging. Patients who are unable to be exposed to solar ultraviolet B radiation are at risk for vitamin D deficiency. In cultures where traditional dress includes long garments, hoods or veils, this may result in reduced sun exposure and vitamin D deficiency (19,20). Discussing potential interactions with healthcare providers is important. PTH enhances osteoclastic bone resorption and distal tubular reabsorption of calcium.

Hypocalcemia is the potential complication after thyroidectomy, where is persistency can lead to serious systemic effects. The aim of this study is to evaluate the incidence of hypocalcemia in thyroidectomy patients. A serum calcium test is a standard blood synthroid afib test that measures the amount of calcium in the blood. Calcium is vital for many bodily functions, so this test is crucial for diagnosing hypocalcemia. During the test, a healthcare provider will collect a blood sample from a vein in the arm, which will then be sent to a lab for analysis.

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You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. Distribution chart of the relationship between calcium and the duration of surgery in the first 48 hours after surgery. Distribution chart of the relationship between calcium and duration of surgery in the first 24 hours after surgery.

Vitamin D supplementation and magnesium supplementation may be recommended to help the body absorb calcium and regulate its levels, respectively. They can be used in cases where Hypocalcemia is due to deficiencies of these nutrients. Ergocalciferol (Vitamin D2) and cholecalciferol (Vitamin D3) are supplements used to treat Vitamin D deficiency and support calcium absorption. In the context of hypocalcemia, it’s used to check for high levels of calcium in the urine, which could indicate problems with calcium regulation in the body. Rickets, a childhood disorder caused by severe vitamin D deficiency, can lead to hypocalcemia.

These patients were excluded for analysis, except for the outcome of persistent hypoparathyroidism, as in all three patients phasing out of supplementation was attempted. Receiver operating characteristic curve analysis was used to identify the optimal cutoff for biochemical variables as a predictor for supplementation and persistent hypoparathyroidism. Correlations were tested by calculating the Pearson’s product–moment correlation coefficient and Spearman’s rank correlation coefficient, where appropriate. A logistic regression model was used to investigate predictors for calcium and/or alfacalcidol supplementation. IBM SPSS , version 25 (IBM Corp.), was used to perform all statistical analyses. For the future, we envision a more individualized treatment approach for patients at risk for delayed symptomatic hypocalcemia, including the proportional change in pre- to post- operative PTH.

Patients in the prospective cohort were typically discharged at POD 1 and thus before this reported average onset of symptoms. Patients who started supplementation after discharge had mild biochemical hypocalcemia during admission, but a significant proportional decrease in pre- to postoperative PTH. Carvalho et al. analyzed a similar group of patients with discordant PTH and calcium concentrations and identified bilateral central neck dissection and a pre- to postoperative PTH reduction as predictors of transient hypocalcemia (33). These findings suggest that PTH measurements may be used to select patients at risk of delayed onset of relevant symptomatic hypocalcemia. Patients who express only the AHO phenotype are described as having PPHP (Table 5). These subjects have normal serum calcium levels and have no other evidence of hormone resistance.

Acute or chronic renal failure, hypomagnesemia, hypoalbuminemia (“factitious hypocalcemia”), medications, or transfusions with citrated blood may all alter levels of serum calcium. Another setting in which hypocalcemia can occur is sepsis and usually confirms a grave prognosis (104). In gram negative sepsis or in the “toxic shock syndrome”, there is a reduction in both total and ionized serum calcium. The mechanism of action remains unknown, but elevated levels of the cytokines IL-6 or TNF-alpha may be mediators of hypocalcemia. Linkage and mutational analysis have identified the gene responsible for the syndrome as GATA3, which encodes a zinc finger transcription factor involved in embryonic development of the parathyroid glands, kidney and otic vesicle (60). Patients are usually asymptomatic with inappropriately normal, given their level of hypocalcemia, or frankly low PTH levels.

An alternative to calcium carbonate is calcium citrate (2000 to 6000 mg per day) administered orally in divided doses for those patients on proton pump inhibitors, elderly patients with achlorhydria, and those who had a gastric bypass. The advantage of calcium carbonate is that it is about 40% elemental calcium, whereas calcium citrate is only 21% elemental calcium. For enhanced absorption, both preparations of calcium should be taken with meals. It is important to administer oral calcium dosing separate from oral thyroid hormone replacement due to the binding of levothyroxine by calcium and inhibiting levothyroxine absorption. Levothyroxine should be taken 1 hour before or 3 hours after calcium is taken.