Ongoing management of hypoparathyroidsim

Hypoparthyroidism (hypopara) is a rare disease caused by absent or low levels of parathyroid hormone (PTH) to be secreted from the parathyroid gland.This causes a mineral imbalance in the body including low blood concentration of calcium (hypocalcaemia), high blood concentration of phosphate (hyperphosphatemia), and reduced levels of activated vitamin D, which reduces absorption of calcium in the gut.

Hypopara is often a chronic, life-long rare diesease which requires on-going management. The best management strategies will vary from person to person, and may change over time. Lifestyle changes can often help in the management of symptoms and improving quality of life (QoL) for those with hypopara.

There are a number of different treatment options for hypopara, but the conventional therapy for patients is a regimen of calcium and active vitamin D supplements. Calcium supplementation maintains calcium levels and can treat the symptoms of hypocalcaemia. PTH has the important role of converting vitamin D in the body to an activated form, which can increase the absorption of calcium; therefore the management of hypopara usually consists of a balance between calcium and vitamin D supplements. Though many patients can manage hypopara with conventional therapy alone, some patients find that conventional therapy is not sufficient to manage their hypopara. Complications can also sometimes occur due to hypercalcaemia as a result of long-term treatment with calcium supplements.

Managing hypopara with your diet

Calcium intake from food can be evenly distributed throughout the day, which can reduce the need for high doses of calcium supplementation. Some patients may choose to try to manage their hypopara through dietary changes; by eating calcium-rich food and avoiding meals with high phosphate content, either with or without a supplement regimen. Natural sources of calcium include: dairy, soya, green leafy vegetables, beans and lentils, nuts, fish and foods made with fortified flour. Dietary phosphate can also be reduced by avoiding processed foods. Activated vitamin D supplements can imrove the rate of absorption of dietary calcium in the intestine. Patients should discuss the best management strategy for them with their physician before changing their diet.

Calcium content of some calcium-rich foods based on the average serving size:

Food Group	Type of Food	Calcium Content (MG)
Dairy	Cow's Milk Yogurt (without fruit) Hard/Soft Cheese Fresh Cheese(e.g. Cottage, Ricotta, Mascarpone Feta	270 - 300 197-207 240 138 270
Fish	Sardines cooked in oil Salmon	240 181
Beans and Lentils	White beans Red beans Chickpeas	132 93 99
Vegetables	Broccoli Cress Kale	112 188 90-95
Nuts	Almonds Hazelnuts	75 56
Dairy and meat alternatives	Soy drink (calcium-enriched) Almond milk Tofu (made with calcium)	240 90 253

Improving your mental and physical wellbeing

Hypopara patients often find that their ability to do physical activity and cognitive tasks can be greatly reduced by their symptoms. Symptoms such as tetany, muscle spasms and fatigue may reduce the ability to do everyday tasks and can greatly reduce a patient's QoL. Many patients report that hypopara impacts their career and relationships, with physical symptoms such as brain fog and fatigue effecting their cognitive abilities, and the physical symptoms restricting their movement and ability to go outside.

A reduction in quality of life can have further impacts on mental health. Hypopara patients often report feelings of depression and anxiey, emotional sensitivity and isolation. These QoL symptoms aren't always treated by conventional therapy. Therefore, it is important for patients get advice from their doctor if they are affected, as they may be able to be referred to other healthcare professionals (such as mental health specialists of physiotherapists). Exercise not only improves mental wellbeing, but will also improve muscle function and control; therefore, patients may find it helpful to try to exersise if they can. Patients may also find it helpful to join patient groups to find support and advice, as well as seek support from family and friends.

Please visit hypaparaanswers.eu for more information on patient support groups.

Managing hypopara during and after pregancy

During pregnancy, natural physiological changes affect the homeostasis of calcium in hypopara patients. The calcium and vitamin D dosage for pregnant patients varies widely. Therefore, physicians may closely monitor calcium levels during pregnancy by taking blood tests every few weeks. The resuls may show varying calcium levels throughout the pregnancy, which may require frequent adjustments in the dose of calcium and vitamin D in order to avoid both hypocalcaemia and hypercalcaemia. Both of these conditions impact the development of the baby's parathyroid and may pose a risk to the mother and baby if untreated. Inadequate treatment of hypopara may also result in an increased risk of miscarriage. However, most women with hypopara have few complications and give birth to healthy babies, providing calcium homeostasis is adequately maintained. Doctors work closely with several specialists to optimise patient care during pregnancy.

Though calcium requirements may increase during pregnancy, after pregnancy, dose requirements for calcium and vitamin D in some patients can decrease. For breastfeeding hypopara patients, their bodies change: vitamin D levels normalise; calcium absorption in the kidney and the gut increases; and phosphate excretion is enhanced. These changes may require management changes to ensure that calcium is maintained in the normal range. Physicians are also likely to frequently monitor hypopara patients after pregnancy.

Calcium and vitamin D supplements are safe during pregnancy and breastfeeding; however, other treatments may be stopped. Pregnant and breastfeeding patients should talk to their physician for advice on the best way to manage hypoara during and after pregnancy.

Managing hypopara during menopause

Menopause is a natural process where a woman's bodies stop having menstrual periods permanently and stop producing the hormone oestrogen. A lack of oestrogen causes an increase in bone reabsorption, which involves the gradual breakdown of bone material to be released in the blood. This leads to decreased bone mineral density which may cause weakened bones and bone fractures. Though Hypopara is associated with increased bone mineral density, menopausal women with postsurgical hypopara are at risk of compromised bone structure and weakened bones. Furthermore, Idiopathic hypopara is associated with a risk of vertebral fractures in post-menopausal women. Physicians may monitor post-menopausal hypopara patients closely through scans to assess their risk of bone weakness and fracture.

Although the exact effects of menopause on hypoara patients is not known, calcium levels may fluctuate during this time and patients should remain vigliant in monitoring their symptoms and QoL, and talk to their physician if they notice changes.

Managing hypoara in childhood

Hypopara in childhood is difficult for both children and their families, particularly as it is usually a life-long condition requiring careful management. Though symptoms vary between patients, those diagnosed in childhood of adolescence may have a higher risk of developing serious symptoms, such as seizures, and long-term complications from treatment, such as calcifications. Therefore, physicians may monitor children with urine tests and carry out physical examinations to assess symptoms. Hypopara in childhood is also associated with dental complications, which may require referral to a dentist.

Parents of carers can also help in managing their child's hypopara. Below are some tips to help parents or carers to manage their child's hypopara:

Be aware of the symptoms of hypocalcaemia. Symptoms vary between patients and can be similar to other health conditions. To inform yourself about the symptoms, please visit hypoparaanswers.eu
Be aware of any changes in your child's symptoms, and seek help from your physician if they worsen or a new symptom arises.
Keep a diary for hospital appointments and note down the date, time and purpose of the visit.
Keep a diary of the medications your child needs and the time of day they need to be taken.
Take note of any new treatments given to your child and ask about why it is being given, any potential side effects if may have and if it need to be taken with or without food.
Take note of the tests your physician carries out, why it is needed, the results of the test and what the results could mean for your child.
Before attending an appoinment write down a list of questions for your physician.
Know where to go and who to call if your child suddenly becomes ill.

Ongoing management of hypoparathyroidsim

Managing hypopara with your diet

Improving your mental and physical wellbeing

Managing hypopara during and after pregancy

Managing hypopara during menopause

Managing hypoara in childhood

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Ongoing management of hypoparathyroidsim

Managing hypopara with your diet

Improving your mental and physical wellbeing

Managing hypopara during and after pregancy

Managing hypopara during menopause

Managing hypoara in childhood

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