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class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 26 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-26" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">26 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%82%D8%B5%D9%88%D8%B1_%D8%AC%D8%A7%D8%B1%D8%A7%D8%AA_%D8%A7%D9%84%D8%AF%D8%B1%D9%82%D9%8A%D8%A9" title="قصور جارات الدرقية – Arabic" lang="ar" hreflang="ar" data-title="قصور جارات الدرقية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Hipoparatireoidizam" title="Hipoparatireoidizam – Bosnian" lang="bs" hreflang="bs" data-title="Hipoparatireoidizam" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Hipoparatiro%C3%AFdisme" title="Hipoparatiroïdisme – Catalan" lang="ca" hreflang="ca" data-title="Hipoparatiroïdisme" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Hypoparathyreoidismus" title="Hypoparathyreoidismus – German" lang="de" hreflang="de" data-title="Hypoparathyreoidismus" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Hipoparatiroidismo" title="Hipoparatiroidismo – Spanish" lang="es" hreflang="es" data-title="Hipoparatiroidismo" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Hipoparatiroidismo" title="Hipoparatiroidismo – Basque" lang="eu" hreflang="eu" data-title="Hipoparatiroidismo" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%DA%A9%D9%85%E2%80%8C%DA%A9%D8%A7%D8%B1%DB%8C_%D9%BE%D8%A7%D8%B1%D8%A7%D8%AA%DB%8C%D8%B1%D9%88%D8%A6%DB%8C%D8%AF" title="کم‌کاری پاراتیروئید – Persian" lang="fa" hreflang="fa" data-title="کم‌کاری پاراتیروئید" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Hypoparathyro%C3%AFdie" title="Hypoparathyroïdie – French" lang="fr" hreflang="fr" data-title="Hypoparathyroïdie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%B6%80%EA%B0%91%EC%83%81%EC%84%A0_%EA%B8%B0%EB%8A%A5_%EC%A0%80%ED%95%98%EC%A6%9D" title="부갑상선 기능 저하증 – Korean" lang="ko" hreflang="ko" data-title="부갑상선 기능 저하증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Hipoparatireoidizam" title="Hipoparatireoidizam – Croatian" lang="hr" hreflang="hr" data-title="Hipoparatireoidizam" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Hipoparatiroidisme" title="Hipoparatiroidisme – Indonesian" lang="id" hreflang="id" data-title="Hipoparatiroidisme" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Ipoparatiroidismo" title="Ipoparatiroidismo – Italian" lang="it" hreflang="it" data-title="Ipoparatiroidismo" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%99%D7%A4%D7%95%D7%A4%D7%A8%D7%AA%D7%99%D7%A8%D7%95%D7%90%D7%99%D7%93%D7%99%D7%96%D7%9D" title="היפופרתירואידיזם – Hebrew" lang="he" hreflang="he" data-title="היפופרתירואידיזם" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%93%D0%B8%D0%BF%D0%BE%D0%BF%D0%B0%D1%80%D0%B0%D1%82%D0%B8%D1%80%D0%B5%D0%BE%D0%B7" title="Гипопаратиреоз – Kyrgyz" lang="ky" hreflang="ky" data-title="Гипопаратиреоз" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%89%AF%E7%94%B2%E7%8A%B6%E8%85%BA%E6%A9%9F%E8%83%BD%E4%BD%8E%E4%B8%8B%E7%97%87" title="副甲状腺機能低下症 – Japanese" lang="ja" hreflang="ja" data-title="副甲状腺機能低下症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B9%E0%AC%BE%E0%AC%87%E0%AC%AA%E0%AD%8B%E0%AC%AA%E0%AC%BE%E0%AC%B0%E0%AC%BE%E0%AC%A5%E0%AC%BE%E0%AC%87%E0%AC%B0%E0%AC%8F%E0%AC%A1%E0%AC%BF%E0%AC%9C%E0%AD%8D%E0%AC%AE" title="ହାଇପୋପାରାଥାଇରଏଡିଜ୍ମ – Odia" lang="or" hreflang="or" data-title="ହାଇପୋପାରାଥାଇରଏଡିଜ୍ମ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Gipoparatireoz" title="Gipoparatireoz – Uzbek" lang="uz" hreflang="uz" data-title="Gipoparatireoz" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Niedoczynno%C5%9B%C4%87_przytarczyc" title="Niedoczynność przytarczyc – Polish" lang="pl" hreflang="pl" data-title="Niedoczynność przytarczyc" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Hipoparatireoidismo" title="Hipoparatireoidismo – Portuguese" lang="pt" hreflang="pt" data-title="Hipoparatireoidismo" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%93%D0%B8%D0%BF%D0%BE%D0%BF%D0%B0%D1%80%D0%B0%D1%82%D0%B8%D1%80%D0%B5%D0%BE%D0%B7" title="Гипопаратиреоз – Russian" lang="ru" hreflang="ru" data-title="Гипопаратиреоз" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Hipoparatiroidizem" title="Hipoparatiroidizem – Slovenian" lang="sl" hreflang="sl" data-title="Hipoparatiroidizem" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Hipoparatireoidizam" title="Hipoparatireoidizam – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Hipoparatireoidizam" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Hypoparatyreos" title="Hypoparatyreos – Swedish" lang="sv" hreflang="sv" data-title="Hypoparatyreos" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%93%D1%96%D0%BF%D0%BE%D0%BF%D0%B0%D1%80%D0%B0%D1%82%D0%B8%D1%80%D0%B5%D0%BE%D1%97%D0%B4%D0%B8%D0%B7%D0%BC" title="Гіпопаратиреоїдизм – Ukrainian" lang="uk" hreflang="uk" data-title="Гіпопаратиреоїдизм" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Suy_tuy%E1%BA%BFn_c%E1%BA%ADn_gi%C3%A1p" title="Suy tuyến cận giáp – Vietnamese" lang="vi" hreflang="vi" data-title="Suy tuyến cận giáp" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E5%89%AF%E7%94%B2%E7%8B%80%E8%85%BA%E5%8A%9F%E8%83%BD%E4%BD%8E%E4%B8%8B%E7%97%87" title="副甲狀腺功能低下症 – Chinese" lang="zh" hreflang="zh" data-title="副甲狀腺功能低下症" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q1586088#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu vector-menu-tabs mw-portlet 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.infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Hypoparathyroidism</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Hypocalcemia</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Recombinant_human_parathyroid_hormone" title="Recombinant human parathyroid hormone">Recombinant human parathyroid hormone</a>, <a href="/wiki/Palopegteriparatide" title="Palopegteriparatide">palopegteriparatide</a></td></tr></tbody></table> <p><b>Hypoparathyroidism</b> is decreased function of the <a href="/wiki/Parathyroid_gland" title="Parathyroid gland">parathyroid glands</a> with underproduction of <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">parathyroid hormone</a> (PTH). This can lead to <a href="/wiki/Hypocalcemia" title="Hypocalcemia">low levels of calcium in the blood</a>, often causing <a href="/wiki/Cramp" title="Cramp">cramping</a> and twitching of muscles or <a href="/wiki/Tetany_(medical_sign)" class="mw-redirect" title="Tetany (medical sign)">tetany</a> (involuntary muscle contraction), and several other symptoms. It is a very rare disease. The condition can be inherited, but it is also encountered after <a href="/wiki/Thyroidectomy" title="Thyroidectomy">thyroid</a> or <a href="/wiki/Parathyroidectomy" title="Parathyroidectomy">parathyroid gland surgery</a>, and it can be caused by <a href="/wiki/Autoimmunity" title="Autoimmunity">immune system-related damage</a> as well as a number of rarer causes. The diagnosis is made with <a href="/wiki/Blood_test" title="Blood test">blood tests</a>, and other investigations such as <a href="/wiki/Genetic_testing" title="Genetic testing">genetic testing</a> depending on the results. The primary treatment of hypoparathyroidism is calcium and vitamin D supplementation. Calcium replacement or <a href="/wiki/Vitamin_D" title="Vitamin D">vitamin D</a> can ameliorate the symptoms but can increase the risk of <a href="/wiki/Kidney_stone" class="mw-redirect" title="Kidney stone">kidney stones</a> and <a href="/wiki/Chronic_kidney_disease" title="Chronic kidney disease">chronic kidney disease</a>.<sup id="cite_ref-Bilezikian_1-0" class="reference"><a href="#cite_note-Bilezikian-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Additionally, medications such as <a href="/wiki/Recombinant_human_parathyroid_hormone" title="Recombinant human parathyroid hormone">recombinant human parathyroid hormone</a> or <a href="/wiki/Teriparatide" title="Teriparatide">teriparatide</a> may be given by injection to replace the missing hormone.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The main symptoms of hypoparathyroidism are the result of the <a href="/wiki/Hypocalcemia" title="Hypocalcemia">low blood calcium level</a>, which interferes with normal <a href="/wiki/Muscle_contraction" title="Muscle contraction">muscle contraction</a> and <a href="/wiki/Action_potential" title="Action potential">nerve conduction</a>. As a result, people with hypoparathyroidism can experience <a href="/wiki/Paresthesia" title="Paresthesia">paresthesia</a>, an unpleasant tingling sensation around the mouth and in the hands and feet, as well as muscle cramps and severe spasms known as "<a href="/wiki/Tetany" title="Tetany">tetany</a>" that affect the hands and feet.<sup id="cite_ref-Shoback_3-0" class="reference"><a href="#cite_note-Shoback-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Many also report a number of subjective symptoms such as <a href="/wiki/Fatigue_(medical)" class="mw-redirect" title="Fatigue (medical)">fatigue</a>, <a href="/wiki/Headache" title="Headache">headaches</a>, <a href="/wiki/Bone_pain" title="Bone pain">bone pain</a> and <a href="/wiki/Insomnia" title="Insomnia">insomnia</a>.<sup id="cite_ref-Bilezikian_1-1" class="reference"><a href="#cite_note-Bilezikian-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Crampy <a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pain</a> may occur.<sup id="cite_ref-Potts_4-0" class="reference"><a href="#cite_note-Potts-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Physical_examination" title="Physical examination">Physical examination</a> of someone with <a href="/wiki/Hypocalcemia" title="Hypocalcemia">hypocalcemia</a> may show tetany, but it is also possible to provoke tetany of the facial muscles by tapping on the <a href="/wiki/Facial_nerve" title="Facial nerve">facial nerve</a> (a phenomenon known as <a href="/wiki/Chvostek_sign" title="Chvostek sign">Chvostek's sign</a>) or by using the cuff of a <a href="/wiki/Sphygmomanometer" title="Sphygmomanometer">sphygmomanometer</a> to temporarily obstruct the blood flow to the arm (a phenomenon known as <a href="/wiki/Trousseau_sign_of_latent_tetany" title="Trousseau sign of latent tetany">Trousseau's sign of latent tetany</a>).<sup id="cite_ref-Potts_4-1" class="reference"><a href="#cite_note-Potts-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>A number of <a href="/wiki/Medical_emergency" title="Medical emergency">medical emergencies</a> can arise in people with low calcium levels. These are <a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">seizures</a>, <a href="/wiki/Cardiac_dysrhythmia" class="mw-redirect" title="Cardiac dysrhythmia">severe irregularities in the normal heart beat</a> (specifically <a href="/wiki/QT_prolongation" class="mw-redirect" title="QT prolongation">prolongation of the QT interval</a>), as well as spasm of the <a href="/wiki/Laryngospasm" title="Laryngospasm">upper part of the airways</a> or the <a href="/wiki/Bronchospasm" title="Bronchospasm">smaller airways known as the bronchi</a> (both potentially causing <a href="/wiki/Respiratory_failure" title="Respiratory failure">respiratory failure</a>).<sup id="cite_ref-Bilezikian_1-2" class="reference"><a href="#cite_note-Bilezikian-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gafni_2019_5-0" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Related_conditions">Related conditions</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=2" title="Edit section: Related conditions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <table cellpadding="5" class="wikitable"> <tbody><tr> <th colspan="2">Condition </th> <th>Appearance </th> <th><a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">PTH</a> levels </th> <th><a href="/wiki/Calcitriol" title="Calcitriol">Calcitriol</a> </th> <th><a href="/wiki/Calcium" title="Calcium">Calcium</a> </th> <th><a href="/wiki/Phosphates" class="mw-redirect" title="Phosphates">Phosphates</a> </th> <th><a href="/wiki/Genomic_imprinting" title="Genomic imprinting">Imprinting</a> </th></tr> <tr> <td colspan="2">Hypoparathyroidism </td> <td>Normal </td> <td>Low </td> <td>Low </td> <td>Low </td> <td>High </td> <td>Not applicable </td></tr> <tr> <td rowspan="3"><a href="/wiki/Pseudohypoparathyroidism" title="Pseudohypoparathyroidism">Pseudohypoparathyroidism</a> </td> <td align="center">Type 1A </td> <td><a href="/wiki/Albright%27s_hereditary_osteodystrophy" title="Albright's hereditary osteodystrophy">Skeletal defects</a> </td> <td>High </td> <td>Low </td> <td>Low </td> <td>High </td> <td>Gene defect from mother (<a href="/wiki/GNAS1" class="mw-redirect" title="GNAS1">GNAS1</a>) </td></tr> <tr> <td align="center">Type 1B </td> <td>Normal </td> <td>High </td> <td>Low </td> <td>Low </td> <td>High </td> <td>Gene defect from mother (<a href="/wiki/GNAS1" class="mw-redirect" title="GNAS1">GNAS1</a> and <a href="/wiki/STX16" title="STX16">STX16</a>) </td></tr> <tr> <td align="center">Type 2 </td> <td>Normal </td> <td>High </td> <td>Low </td> <td>Low </td> <td>High </td> <td>? </td></tr> <tr> <td colspan="2"><a href="/wiki/Pseudopseudohypoparathyroidism" title="Pseudopseudohypoparathyroidism">Pseudopseudohypoparathyroidism</a> </td> <td><a href="/wiki/Albright%27s_hereditary_osteodystrophy" title="Albright's hereditary osteodystrophy">Skeletal defects</a> </td> <td>Normal </td> <td>Normal </td> <td>Normal<sup id="cite_ref-HussainLatif2010_6-0" class="reference"><a href="#cite_note-HussainLatif2010-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </td> <td>Normal </td> <td>gene defect from father </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=3" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hypoparathyroidism can have the following causes:<sup id="cite_ref-Bilezikian_1-3" class="reference"><a href="#cite_note-Bilezikian-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Removal of, or trauma to, the parathyroid glands due to anterior neck surgery (including <a href="/wiki/Thyroid" title="Thyroid">thyroid</a> surgery) (<a href="/wiki/Thyroidectomy" title="Thyroidectomy">thyroidectomy</a>), parathyroid surgery (parathyroidectomy). This is the most common cause of hypoparathyroidism, with 78% of cases of hypoparathyroidism arising due to a complication of anterior neck surgery.<sup id="cite_ref-Gafni_2019_5-1" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Although <a href="/wiki/Surgery" title="Surgery">surgeons</a> generally make attempts to spare normal parathyroid glands at surgery, inadvertent injury to the glands or their blood supply is still common. When this happens, the parathyroids may cease functioning. This is usually temporary but occasionally long term (permanent). Hypoparathyroidism may occur as a complication in up to 8% of anterior neck surgeries with 75% of those resolving by 6 months, and 25% of those having permanent hypoparathyroidism.<sup id="cite_ref-Gafni_2019_5-2" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Kenny%E2%80%93Caffey_syndrome" title="Kenny–Caffey syndrome">Kenny–Caffey syndrome</a></li> <li><a href="/wiki/Autoimmune_disorder" class="mw-redirect" title="Autoimmune disorder">Autoimmune</a> invasion and destruction is the most common non-surgical cause. It can occur as part of <a href="/wiki/Autoimmune_polyendocrine_syndrome" title="Autoimmune polyendocrine syndrome">autoimmune polyendocrine syndromes</a>.</li> <li><a href="/wiki/Hemochromatosis" class="mw-redirect" title="Hemochromatosis">Hemochromatosis</a> can lead to iron accumulation and consequent dysfunction of a number of endocrine organs, including the parathyroids.</li> <li>Absence or dysfunction of the parathyroid glands is one of the components of <a href="/wiki/Chromosome_22,_microdeletion_22_q11" class="mw-redirect" title="Chromosome 22, microdeletion 22 q11">chromosome 22q11 microdeletion syndrome</a> (other names: DiGeorge syndrome, Schprintzen syndrome, velocardiofacial syndrome).</li> <li><a href="/wiki/Magnesium_deficiency_(medicine)" class="mw-redirect" title="Magnesium deficiency (medicine)">Magnesium deficiency</a></li> <li>A defect in the calcium receptor leads to a rare congenital form of the disease</li> <li>Idiopathic (of unknown cause)</li> <li>Occasionally due to other hereditary causes (e.g. <a href="/wiki/Barakat_syndrome" title="Barakat syndrome">Barakat syndrome</a> (HDR syndrome) a genetic development disorder resulting in hypoparathyroidism, sensorineural deafness, and kidney disease)</li></ul> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=4" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The parathyroid glands are so named because they are usually located behind the <a href="/wiki/Thyroid" title="Thyroid">thyroid gland</a> in the neck. They arise during <a href="/wiki/Human_embryogenesis" class="mw-redirect" title="Human embryogenesis">fetal development</a> from structures known as the third and fourth <a href="/wiki/Pharyngeal_pouch_(embryology)" title="Pharyngeal pouch (embryology)">pharyngeal pouch</a>. The glands, usually four in number, contain the <a href="/wiki/Parathyroid_chief_cell" title="Parathyroid chief cell">parathyroid chief cells</a> that sense the level of <a href="/wiki/Calcium_in_biology" title="Calcium in biology">calcium</a> in the blood through the <a href="/wiki/Calcium-sensing_receptor" title="Calcium-sensing receptor">calcium-sensing receptor</a> and secrete parathyroid hormone. <a href="/wiki/Magnesium" title="Magnesium">Magnesium</a> is required for PTH secretion. Under normal circumstances, the parathyroid glands secrete PTH to maintain a calcium level within normal limits, as calcium is required for adequate muscle and nerve function (including the <a href="/wiki/Autonomic_nervous_system" title="Autonomic nervous system">autonomic nervous system</a>). </p><p>PTH acts on several organs to regulate calcium levels and phosphorus levels. PTH acts on the kidneys to increase calcium reabsorption into the blood, and to inhibit phosphorus reabsorption (which causes phosphorus to be lost in the urine).<sup id="cite_ref-Gafni_2019_5-3" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> It increases calcium and phosphorus absorption in the bowel indirectly by stimulating the kidneys to produce vitamin D which then acts on the gut.<sup id="cite_ref-Gafni_2019_5-4" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> PTH also causes increase <a href="/wiki/Bone_resorption" title="Bone resorption">bone resorption</a> which leads to the releases calcium and phosphorus into the blood.<sup id="cite_ref-Gafni_2019_5-5" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=5" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diagnosis is by measurement of <a href="/wiki/Calcium" title="Calcium">calcium</a>, <a href="/wiki/Serum_albumin" title="Serum albumin">serum albumin</a> (for correction) and PTH in <a href="/wiki/Blood_test" title="Blood test">blood</a>. If necessary, measuring <a href="/wiki/Cyclic_adenosine_monophosphate" title="Cyclic adenosine monophosphate">cAMP</a> (cyclic AMP) in the urine after an intravenous dose of PTH can help in the distinction between hypoparathyroidism and other causes.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2020)">citation needed</span></a></i>]</sup> </p><p>Differential diagnoses are: </p> <ul><li><a href="/wiki/Pseudohypoparathyroidism" title="Pseudohypoparathyroidism">Pseudohypoparathyroidism</a> (normal PTH levels but tissue insensitivity to the hormone, associated with <a href="/wiki/Intellectual_disability" title="Intellectual disability">intellectual disability</a> and <a href="/wiki/Skeleton" title="Skeleton">skeletal deformities</a>) and <a href="/wiki/Pseudopseudohypoparathyroidism" title="Pseudopseudohypoparathyroidism">pseudopseudohypoparathyroidism</a>.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Vitamin_D#Deficiency" title="Vitamin D">Vitamin D deficiency</a> or hereditary insensitivity to this vitamin (X-linked dominant).</li> <li><a href="/wiki/Malabsorption" title="Malabsorption">Malabsorption</a></li> <li><a href="/wiki/Kidney_disease" title="Kidney disease">Kidney disease</a></li> <li>Medication: <a href="/wiki/Steroid" title="Steroid">steroids</a>, <a href="/wiki/Diuretic" title="Diuretic">diuretics</a>, some <a href="/wiki/Antiepileptic" class="mw-redirect" title="Antiepileptic">antiepileptics</a>.</li></ul> <p>Other tests include <a href="/wiki/Electrocardiography" title="Electrocardiography">ECG</a> for abnormal heart rhythms, and measurement of blood magnesium levels.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2011)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=6" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Severe hypocalcaemia, a potentially life-threatening condition, is treated as soon as possible with <a href="/wiki/Intravenous" class="mw-redirect" title="Intravenous">intravenous</a> <a href="/wiki/Calcium" title="Calcium">calcium</a> (e.g. as <a href="/wiki/Calcium_gluconate" title="Calcium gluconate">calcium gluconate</a>). Calcium gluconate can be given via a <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">peripheral IV</a>, however other calcium formulations require infusion via a <a href="/wiki/Central_venous_catheter" title="Central venous catheter">central venous catheter</a> as the calcium can irritate <a href="/wiki/Peripheral_vein" class="mw-redirect" title="Peripheral vein">peripheral veins</a> and cause <a href="/wiki/Phlebitis" title="Phlebitis">phlebitis</a>.<sup id="cite_ref-Gafni_2019_5-6" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Precautions are taken to prevent seizures or larynx spasms. The heart is monitored for abnormal rhythms during IV treatment as calcium may affect cardiac conduction.<sup id="cite_ref-Gafni_2019_5-7" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> When the life-threatening attack has been controlled, the person is then transitioned to long term therapy with oral or <a href="/wiki/Subcutaneous_injection" class="mw-redirect" title="Subcutaneous injection">subcutaneous injection</a> medications.<sup id="cite_ref-Gafni_2019_5-8" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Long-term treatment of hypoparathyroidism is with <a href="/wiki/Vitamin_D" title="Vitamin D">vitamin D</a> analogs (such as <a href="/wiki/Calcitriol" title="Calcitriol">calcitriol</a> or <a href="/wiki/Alfacalcidol" title="Alfacalcidol">alfacalcidol</a>), vitamin D supplementation and calcium supplementation.<sup id="cite_ref-Gafni_2019_5-9" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Potential risks of treatment for hypoparathyroidism include <a href="/wiki/Hypercalcemia" class="mw-redirect" title="Hypercalcemia">hypercalcemia</a> and <a href="/wiki/Hypercalciuria" title="Hypercalciuria">hypercalciuria</a> (elevated calcium in the urine) which may lead to kidney calcification (<a href="/wiki/Nephrocalcinosis" title="Nephrocalcinosis">nephrocalcinosis</a>) and <a href="/wiki/Chronic_kidney_disease" title="Chronic kidney disease">chronic kidney disease</a>.<sup id="cite_ref-Gafni_2019_5-10" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Calcium levels in the blood and urine (along with other electrolytes) must be monitored during long-term treatment of hypoparathyroidism and blood calcium levels are intentionally kept at the lower limits of normal, or mildly low, specifically to avoid hypercalciuria, kidney calcification and kidney damage.<sup id="cite_ref-Gafni_2019_5-11" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Recombinant_human_parathyroid_hormone" title="Recombinant human parathyroid hormone">Recombinant human parathyroid hormone</a> and <a href="/wiki/Teriparatide" title="Teriparatide">teriparatide</a> (which consists of the first <a href="/wiki/N-terminal" class="mw-redirect" title="N-terminal">N-terminal</a> 34 amino acids of parathyroid hormone, the bioactive portion of the hormone)(PTH 1-34) may be used as a second line therapy in those that have not responded to conventional therapy.<sup id="cite_ref-Gafni_2019_5-12" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Both medication may be given via subcutaneous injections, but the use of pump delivery of synthetic PTH 1-34 provides the closest approach to physiologic PTH replacement therapy.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Recombinant human parathyroid hormone and teriparatide are also associated with a risk of hypercalcemia, hypercalciuria with associated kidney calcification and kidney damage.<sup id="cite_ref-Gafni_2019_5-13" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> If these medications are discontinued, they should be tapered and calcium levels should be closely monitored as the transient PTH depletion after stopping the medications can lead to bone leaching of calcium as a compensatory mechanism to increase calcium levels.<sup id="cite_ref-Gafni_2019_5-14" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>A 2019 systematic review has highlighted that there is a lack of high-quality evidence for the use of vitamin D, calcium, or <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">recombinant parathyroid hormone</a> in the management of both temporary and long-term hypoparathyroidism following thyroidectomy.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Kidney_ultrasound" class="mw-redirect" title="Kidney ultrasound">Kidney ultrasound</a> may be considered periodically to assess for any nephrocalcinosis for those on long term therapy for hypoparathyroidism.<sup id="cite_ref-Gafni_2019_5-15" class="reference"><a href="#cite_note-Gafni_2019-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=7" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Hyperparathyroidism" title="Hyperparathyroidism">Hyperparathyroidism</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypoparathyroidism&action=edit&section=8" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-Bilezikian-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Bilezikian_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Bilezikian_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Bilezikian_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Bilezikian_1-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFBilezikianKhanPottsBrandi2011" class="citation journal cs1">Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, et al. (October 2011). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405491">"Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research"</a>. <i>Journal of Bone and Mineral Research</i>. <b>26</b> (10): <span class="nowrap">2317–</span>2337. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fjbmr.483">10.1002/jbmr.483</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405491">3405491</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21812031">21812031</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Bone+and+Mineral+Research&rft.atitle=Hypoparathyroidism+in+the+adult%3A+epidemiology%2C+diagnosis%2C+pathophysiology%2C+target-organ+involvement%2C+treatment%2C+and+challenges+for+future+research&rft.volume=26&rft.issue=10&rft.pages=%3Cspan+class%3D%22nowrap%22%3E2317-%3C%2Fspan%3E2337&rft.date=2011-10&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3405491%23id-name%3DPMC&rft_id=info%3Apmid%2F21812031&rft_id=info%3Adoi%2F10.1002%2Fjbmr.483&rft.aulast=Bilezikian&rft.aufirst=JP&rft.au=Khan%2C+A&rft.au=Potts%2C+JT&rft.au=Brandi%2C+ML&rft.au=Clarke%2C+BL&rft.au=Shoback%2C+D&rft.au=J%C3%BCppner%2C+H&rft.au=D%27Amour%2C+P&rft.au=Fox%2C+J&rft.au=Rejnmark%2C+L&rft.au=Mosekilde%2C+L&rft.au=Rubin%2C+MR&rft.au=Dempster%2C+D&rft.au=Gafni%2C+R&rft.au=Collins%2C+MT&rft.au=Sliney%2C+J&rft.au=Sanders%2C+J&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3405491&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMannstadtClarkeBilezikianBone2019" class="citation journal cs1">Mannstadt, Michael; Clarke, Bart L; Bilezikian, John P; Bone, Henry; Denham, Douglas; Levine, Michael A; Peacock, Munro; Rothman, Jeffrey; Shoback, Dolores M; Warren, Mark L; Watts, Nelson B; Lee, Hak-Myung; Sherry, Nicole; Vokes, Tamara J (1 November 2019). <a rel="nofollow" class="external text" href="https://academic.oup.com/jcem/article/104/11/5136/5540965">"Safety and Efficacy of 5 Years of Treatment With Recombinant Human Parathyroid Hormone in Adults With Hypoparathyroidism"</a>. <i>The Journal of Clinical Endocrinology & Metabolism</i>. <b>104</b> (11): <span class="nowrap">5136–</span>5147. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1210%2Fjc.2019-01010">10.1210/jc.2019-01010</a></span>. <a href="/wiki/Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://hdl.handle.net/1805%2F22077">1805/22077</a></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Clinical+Endocrinology+%26+Metabolism&rft.atitle=Safety+and+Efficacy+of+5+Years+of+Treatment+With+Recombinant+Human+Parathyroid+Hormone+in+Adults+With+Hypoparathyroidism&rft.volume=104&rft.issue=11&rft.pages=%3Cspan+class%3D%22nowrap%22%3E5136-%3C%2Fspan%3E5147&rft.date=2019-11-01&rft_id=info%3Ahdl%2F1805%2F22077&rft_id=info%3Adoi%2F10.1210%2Fjc.2019-01010&rft.aulast=Mannstadt&rft.aufirst=Michael&rft.au=Clarke%2C+Bart+L&rft.au=Bilezikian%2C+John+P&rft.au=Bone%2C+Henry&rft.au=Denham%2C+Douglas&rft.au=Levine%2C+Michael+A&rft.au=Peacock%2C+Munro&rft.au=Rothman%2C+Jeffrey&rft.au=Shoback%2C+Dolores+M&rft.au=Warren%2C+Mark+L&rft.au=Watts%2C+Nelson+B&rft.au=Lee%2C+Hak-Myung&rft.au=Sherry%2C+Nicole&rft.au=Vokes%2C+Tamara+J&rft_id=https%3A%2F%2Facademic.oup.com%2Fjcem%2Farticle%2F104%2F11%2F5136%2F5540965&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-Shoback-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-Shoback_3-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFShoback2008" class="citation journal cs1">Shoback D (July 2008). "Clinical practice. Hypoparathyroidism". <i>The New England Journal of Medicine</i>. <b>359</b> (4): <span class="nowrap">391–</span>403. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJMcp0803050">10.1056/NEJMcp0803050</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18650515">18650515</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+England+Journal+of+Medicine&rft.atitle=Clinical+practice.+Hypoparathyroidism&rft.volume=359&rft.issue=4&rft.pages=%3Cspan+class%3D%22nowrap%22%3E391-%3C%2Fspan%3E403&rft.date=2008-07&rft_id=info%3Adoi%2F10.1056%2FNEJMcp0803050&rft_id=info%3Apmid%2F18650515&rft.aulast=Shoback&rft.aufirst=D&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-Potts-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-Potts_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Potts_4-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPotts_Jr_JT2005" class="citation book cs1">Potts Jr JT (2005). "Diseases of the parathyroid gland". In Kasper DL, Braunwald E, Fauci AS, et al. (eds.). <i>Harrison's Principles of Internal Medicine</i> (16th ed.). New York, NY: McGraw-Hill. pp. <span class="nowrap">2249–</span>68. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-139140-5" title="Special:BookSources/978-0-07-139140-5"><bdi>978-0-07-139140-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Diseases+of+the+parathyroid+gland&rft.btitle=Harrison%27s+Principles+of+Internal+Medicine&rft.place=New+York%2C+NY&rft.pages=%3Cspan+class%3D%22nowrap%22%3E2249-%3C%2Fspan%3E68&rft.edition=16th&rft.pub=McGraw-Hill&rft.date=2005&rft.isbn=978-0-07-139140-5&rft.au=Potts+Jr+JT&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-Gafni_2019-5"><span class="mw-cite-backlink">^ <a href="#cite_ref-Gafni_2019_5-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-Gafni_2019_5-15"><sup><i><b>p</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGafniCollins2019" class="citation journal cs1">Gafni, Rachel I.; Collins, Michael T. (2 May 2019). "Hypoparathyroidism". <i>New England Journal of Medicine</i>. <b>380</b> (18): <span class="nowrap">1738–</span>1747. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2FNEJMcp1800213">10.1056/NEJMcp1800213</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Hypoparathyroidism&rft.volume=380&rft.issue=18&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1738-%3C%2Fspan%3E1747&rft.date=2019-05-02&rft_id=info%3Adoi%2F10.1056%2FNEJMcp1800213&rft.aulast=Gafni&rft.aufirst=Rachel+I.&rft.au=Collins%2C+Michael+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-HussainLatif2010-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-HussainLatif2010_6-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFShahid_HussainSharif_Aaron_LatifAdrian_Hall2010" class="citation book cs1">Shahid Hussain; Sharif Aaron Latif; Adrian Hall (1 July 2010). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=rOliqVIROGcC&pg=PA262"><i>Rapid Review of Radiology</i></a>. Manson Publishing. pp. 262–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-84076-120-7" title="Special:BookSources/978-1-84076-120-7"><bdi>978-1-84076-120-7</bdi></a><span class="reference-accessdate">. Retrieved <span class="nowrap">30 October</span> 2010</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Rapid+Review+of+Radiology&rft.pages=262-&rft.pub=Manson+Publishing&rft.date=2010-07-01&rft.isbn=978-1-84076-120-7&rft.au=Shahid+Hussain&rft.au=Sharif+Aaron+Latif&rft.au=Adrian+Hall&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DrOliqVIROGcC%26pg%3DPA262&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-7">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMaedaFortesOliveiraBorba2006" class="citation journal cs1">Maeda, Sergio S.; Fortes, Erika M.; Oliveira, Ulisses M.; Borba, Victoria C. Z.; Lazaretti-Castro, Marise (August 2006). <a rel="nofollow" class="external text" href="https://www.scielo.br/j/abem/a/y89B6N3gz4tMZfFYQKQ6qpq/?lang=en">"Hypoparathyroidism and pseudohypoparathyroidism"</a>. <i>Arquivos Brasileiros de Endocrinologia & Metabologia</i>. <b>50</b>: <span class="nowrap">664–</span>673. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1590%2FS0004-27302006000400012">10.1590/S0004-27302006000400012</a></span>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1677-9487">1677-9487</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arquivos+Brasileiros+de+Endocrinologia+%26+Metabologia&rft.atitle=Hypoparathyroidism+and+pseudohypoparathyroidism&rft.volume=50&rft.pages=%3Cspan+class%3D%22nowrap%22%3E664-%3C%2Fspan%3E673&rft.date=2006-08&rft_id=info%3Adoi%2F10.1590%2FS0004-27302006000400012&rft.issn=1677-9487&rft.aulast=Maeda&rft.aufirst=Sergio+S.&rft.au=Fortes%2C+Erika+M.&rft.au=Oliveira%2C+Ulisses+M.&rft.au=Borba%2C+Victoria+C.+Z.&rft.au=Lazaretti-Castro%2C+Marise&rft_id=https%3A%2F%2Fwww.scielo.br%2Fj%2Fabem%2Fa%2Fy89B6N3gz4tMZfFYQKQ6qpq%2F%3Flang%3Den&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> <li id="cite_note-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-8">^</a></b></span> <span class="reference-text">Winer KK, Yanovski JA, Cutler GB Jr. Synthetic human parathyroid hormone 1-34 vs calcitriol and calcium in the treatment of hypoparathyroidism: Results of a randomized crossover trial" <i>JAMA</i> 1996;276:631-636</span> </li> <li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text">Winer KK, Zhang B, Shrader J, et al. Synthetic human parathyroid hormone 1-34 replacement therapy: A randomized crossover trial comparing pump versus injections in the treatment of chronic hypoparathyroidism. J Clin Endocrinol Metab. Nov.2011.</span> </li> <li id="cite_note-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-10">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFEdafeMechBalasubramanian2019" class="citation journal cs1">Edafe O, Mech CE, Balasubramanian SP, et al. (Cochrane Metabolic and Endocrine Disorders Group) (May 2019). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530809">"Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism"</a>. <i>The Cochrane Database of Systematic Reviews</i>. <b>2019</b> (5): CD012845. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2F14651858.CD012845.pub2">10.1002/14651858.CD012845.pub2</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530809">6530809</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/31116878">31116878</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Calcium%2C+vitamin+D+or+recombinant+parathyroid+hormone+for+managing+post-thyroidectomy+hypoparathyroidism&rft.volume=2019&rft.issue=5&rft.pages=CD012845&rft.date=2019-05&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6530809%23id-name%3DPMC&rft_id=info%3Apmid%2F31116878&rft_id=info%3Adoi%2F10.1002%2F14651858.CD012845.pub2&rft.aulast=Edafe&rft.aufirst=O&rft.au=Mech%2C+CE&rft.au=Balasubramanian%2C+SP&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6530809&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypoparathyroidism" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a 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class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1586088" class="extiw" title="d:Q1586088">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#1708733050">5A50</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/E20">E20</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/E89.2">E89.2</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/P71.4">P71.4</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=252.1">252.1</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/146200">146200</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D007011">D007011</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb6490.htm">6490</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000385.htm">000385</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/1131-overview">med/1131</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/emerg/topic276.htm#">emerg/276</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/ped/topic1125.htm#">ped/1125</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/hypoparathyroidism-pro">Hypoparathyroidism</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Parathyroid_disease73" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini 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navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Primary_hyperparathyroidism" title="Primary hyperparathyroidism">Primary</a></li> <li><a href="/wiki/Secondary_hyperparathyroidism" title="Secondary hyperparathyroidism">Secondary</a></li> <li><a href="/wiki/Tertiary_hyperparathyroidism" title="Tertiary hyperparathyroidism">Tertiary</a></li> <li><a href="/wiki/Osteitis_fibrosa_cystica" title="Osteitis fibrosa cystica">Osteitis fibrosa cystica</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Parathyroiditis" title="Parathyroiditis">Parathyroiditis</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link 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title="Nephrology">Nephrology</a></li> <li><a href="/wiki/Oncology" title="Oncology">Oncology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li> <li><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and<br />gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" title="Urogynecology">Urogynecology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Radiology" title="Radiology">Radiology</a> <ul><li><a href="/wiki/Interventional_radiology" title="Interventional radiology">Interventional radiology</a></li> <li><a href="/wiki/Neuroradiology" title="Neuroradiology">Neuroradiology</a></li> <li><a href="/wiki/Nuclear_medicine" title="Nuclear medicine">Nuclear medicine</a></li></ul></li> <li><a href="/wiki/Pathology" title="Pathology">Pathology</a> <ul><li><a href="/wiki/Anatomical_pathology" title="Anatomical pathology">Anatomical</a></li> <li><a href="/wiki/Clinical_pathology" title="Clinical pathology">Clinical pathology</a></li> <li><a href="/wiki/Clinical_chemistry" title="Clinical chemistry">Clinical chemistry</a></li> <li><a href="/wiki/Cytopathology" title="Cytopathology">Cytopathology</a></li> <li><a href="/wiki/Medical_microbiology" title="Medical microbiology">Medical microbiology</a></li> <li><a href="/wiki/Transfusion_medicine" title="Transfusion medicine">Transfusion medicine</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Addiction medicine</a></li> <li><a href="/wiki/Adolescent_medicine" title="Adolescent medicine">Adolescent medicine</a></li> <li><a href="/wiki/Anesthesiology" title="Anesthesiology">Anesthesiology</a> <ul><li><a href="/wiki/Obstetric_anesthesiology" title="Obstetric anesthesiology">Obstetric anesthesiology</a></li> <li><a href="/wiki/Neurosurgical_anesthesia" title="Neurosurgical anesthesia">Neurosurgical anesthesiology</a></li></ul></li> <li><a href="/wiki/Aviation_medicine" title="Aviation medicine">Aviation medicine</a></li> <li><a href="/wiki/Dermatology" title="Dermatology">Dermatology</a></li> <li><a href="/wiki/Disaster_medicine" title="Disaster medicine">Disaster medicine</a></li> <li><a href="/wiki/Diving_medicine" title="Diving medicine">Diving medicine</a></li> <li><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency medicine</a> <ul><li><a href="/wiki/Mass_gathering_medicine" title="Mass gathering medicine">Mass gathering medicine</a></li></ul></li> <li><a href="/wiki/Evolutionary_medicine" title="Evolutionary medicine">Evolutionary medicine</a></li> <li><a href="/wiki/Family_medicine" title="Family medicine">Family medicine</a> / <a href="/wiki/General_practice" title="General practice">General 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href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a> <ul><li><a href="/wiki/Neonatology" title="Neonatology">Neonatology</a></li></ul></li> <li><a href="/wiki/Phlebologist" class="mw-redirect" title="Phlebologist">Phlebology</a></li> <li><a href="/wiki/Physical_medicine_and_rehabilitation" title="Physical medicine and rehabilitation">Physical medicine and rehabilitation</a> (PM&R)</li> <li><a href="/wiki/Preventive_healthcare" title="Preventive healthcare">Preventive medicine</a></li> <li><a href="/wiki/Prison_healthcare" title="Prison healthcare">Prison healthcare</a></li> <li><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a> <ul><li><a href="/wiki/Addiction_psychiatry" title="Addiction psychiatry">Addiction psychiatry</a></li></ul></li> <li><a href="/wiki/Radiation_therapy" title="Radiation therapy">Radiation oncology</a></li> <li><a href="/wiki/Reproductive_medicine" title="Reproductive medicine">Reproductive medicine</a></li> <li><a href="/wiki/Sexual_medicine" title="Sexual medicine">Sexual medicine</a> <ul><li><a href="/wiki/Venereology" title="Venereology">Venereology</a></li></ul></li> <li><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a></li> <li><a href="/wiki/Sports_medicine" title="Sports medicine">Sports medicine</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplantation medicine</a></li> <li><a href="/wiki/Tropical_medicine" title="Tropical medicine">Tropical medicine</a> <ul><li><a href="/wiki/Travel_medicine" title="Travel medicine">Travel medicine</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_education" title="Medical education">Medical<br />education</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Medical_school" title="Medical school">Medical school</a></li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a></li> <li><a href="/wiki/Bachelor_of_Medical_Sciences" title="Bachelor of Medical Sciences">Bachelor of Medical Sciences</a></li> <li><a href="/wiki/Master_of_Medicine" title="Master of Medicine">Master of Medicine</a></li> <li><a href="/wiki/Master_of_Surgery" title="Master of Surgery">Master of Surgery</a></li> <li><a href="/wiki/Doctor_of_Medicine" title="Doctor of Medicine">Doctor of Medicine</a></li> <li><a href="/wiki/Doctor_of_Osteopathic_Medicine" title="Doctor of Osteopathic Medicine">Doctor of Osteopathic Medicine</a></li> <li><a href="/wiki/MD%E2%80%93PhD" title="MD–PhD">MD–PhD</a> <ul><li><a href="/wiki/Medical_Scientist_Training_Program" title="Medical Scientist Training Program">Medical Scientist Training Program</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alternative_medicine" title="Alternative medicine">Alternative medicine</a></li> <li><a href="/wiki/Allied_health_professions" title="Allied health professions">Allied health</a></li> <li><a href="/wiki/Molecular_oncology" title="Molecular oncology">Molecular oncology</a></li> <li><a href="/wiki/Nanomedicine" title="Nanomedicine">Nanomedicine</a></li> <li><a href="/wiki/Personalized_medicine" title="Personalized medicine">Personalized medicine</a></li> <li><a href="/wiki/Public_health" title="Public health">Public health</a></li> <li><a href="/wiki/Rural_health" title="Rural health">Rural health</a></li> <li><a href="/wiki/Therapy" title="Therapy">Therapy</a></li> <li><a href="/wiki/Traditional_medicine" title="Traditional medicine">Traditional medicine</a></li> <li><a href="/wiki/Veterinary_medicine" title="Veterinary 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