Hypoparathyroidism physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Physical examination of patients with hypoparathyroidism is usually due to hypocalcemia. The presence of tetany on physical examination is diagnostic of hypocalcemia which is commonly caused by hypoparathyroidism. The presence of Chvostek’s sign and Trousseau’s sign on physical examination is highly suggestive of hypocalcemia which is commonly caused by hypoparathyroidism.

• Physical examination of patients with hypoparathyroidism is usually due to hypocalcemia.^[1][2]
• The presence of tetany on physical examination is diagnostic of hypocalcemia which is commonly caused by hypoparathyroidism.^[3]
• The presence of Chvostek’s sign and Trousseau’s sign on physical examination is highly suggestive of hypocalcemia which is commonly caused by hypoparathyroidism.^[4]

• Patients with hypoparathyroidism usually have neuromuscular irritability and may appear dysphoric.

Some patient may have:

• Bradycardia

Careful examination of skin around neck should be done for surgical scar.

Common signs present are:

• Dry skin
• Coarse hair
• Brittle nails
• Alopecia (patchy)

Some patient may have:

• Vitiligo

Some patients may have:

• Subcapsular cataracts
• Papilledema^[5]

Some pediatric patients may have:

• Enamel hypoplasia
• Shortened premolar roots
• Thickened lamina dura
• Delayed tooth eruption
• Dental caries

Some patients may have:

• Dyspnea
• Wheezing

Some patients may have:

• Palpitation
• Signs of congestive heart failure such as fluid overload (S3 gallop)^[6]

• Signs of cardiomyopathy^[7]

Some patients may have:

• Dysphagia

Most common presentation is due to neuromuscular irritability. It present as:

• Tetany
• Chvostek’s sign: Facial twitching, especially around the mouth. It is elicited by tapping the cheek (2 cm anterior to the earlobe below the zygomatic process) over the path of the facial nerve. Ipsilateral twitching of the upper lip is considered as positive sign.
• Trousseau’s sign: Painful carpal spasm. It is elicited by inflating a blood pressure cuff around the arm to a pressure 20 mm Hg above obliteration of the radial pulse for 3-5 minutes.
• Tingling, burning, and/or numbness in the fingertips, toes and lips
• Muscle weakness
• Signs of increased intracranial pressure
• Dystonic spasms

Some patients may have:

• Intellectual disability
• Confusion
• Disorientation

Some patients may have extrapyramidal signs (due to calcification of basal ganglia):^[8]

• Parkinsonism
• Choreoathetosis
• Dystonia
• Oculogyric crisis
• Hemiballismus

Some patients may have psychiatric manifestations:^[9][10]

• Anxiety
• Depression
• Irritability
• Psychosis
• Anxiety
• Memory disturbances
• Reduced concentration

Some patients may have:

• Edema due to cardiac dysfunction

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