How should I manage a patient with hypoparathyroidism who presents with symptomatic hypocalcemia?

Management of a patient with hypoparathyroidism presenting with symptomatic hypocalcaemia requires prompt correction of serum calcium levels to alleviate symptoms and prevent complications. Initial treatment involves administration of intravenous calcium gluconate for acute symptomatic hypocalcaemia, especially if symptoms are severe (e.g., tetany, seizures, cardiac arrhythmias), to rapidly restore serum calcium levels. This should be done under cardiac monitoring due to the risk of arrhythmias. Once acute symptoms are controlled, maintenance therapy with oral calcium supplements and active vitamin D analogues (such as calcitriol) is essential to maintain serum calcium in the low-normal range and prevent recurrence of symptoms ¹; (Tecilazich et al., 2018).

Regular monitoring of serum calcium, phosphate, magnesium, and renal function is important to avoid complications such as hypercalciuria and nephrocalcinosis. Magnesium levels should be corrected if low, as hypomagnesaemia can worsen hypocalcaemia (Tecilazich et al., 2018). The goal is to maintain serum calcium at a level sufficient to prevent symptoms but avoid hypercalcaemia and hypercalciuria, which can cause renal damage ¹.

In some cases, recombinant human parathyroid hormone (rhPTH) therapy may be considered for patients who are difficult to control with conventional therapy, although this is generally reserved for specialist care and not first-line in primary care ¹; (Di Maio et al., 2018). Patient education on adherence, symptom recognition, and the importance of regular follow-up is critical to long-term management.