The hallmark of acute hypocalcemia due to hypoparathyroidism is tetany. A positive history of neck surgery and symptoms of hypocalcemia are suggestive of hypoparathyroidism. The most common symptoms of hypoparathyroidism include tetany (paresthesia, carpopedal spasms, and circumoral numbness). Common symptoms of hypoparathyroidism include abdominal pain, biliary colic, fatigue, muscle cramps, myoclonic jerks, new onset seizure due to hypocalcemia or worsening of seizures, and painful menstruation. Less common symptoms of hypoparathyroidism include cognitive impairment, decreased concentration, hoarseness, palpitations, personality disturbances and/or mood changes, symptoms of acute cardiomyopathy, wheezing, and dyspnea.

Patients with hypoparathyroidism may have a positive history of:^[1][2]

• History of neck surgery
• A family history of hypocalcemia and/or hypoparathyroidism
• A history of other autoimmune endocrinopathies (e.g., adrenal insufficiency)
• A history of candidiasis
• Immunodeficiency

• Clinical symptoms depends on two features:^[3]
  • Acuteness of hypocalcemia
  • The absolute level of serum calcium
• Patients presents dramatically and tends to have more symptoms if there is an acute hypocalcemia compared to patients with chronic hypocalcemia.^[4]

Common symptoms of hypoparathyroidism include:^[3][5]

• Tetany (hallmark of acute hypocalcemia)
  • Paresthesia in fingertips, toes, perioral area
  • Carpopedal spasms
  • Circumoral numbness
• Abdominal pain
• Biliary colic
• Fatigue
• Muscle cramps
• Myoclonic jerks
• New onset seizure due to hypocalcemia or worsening of seizures^[6]

Less common symptoms of hypoparathyroidism include:^[3][5]

• Cognitive impairment
• Hoarseness (due to laryngospasm)
• Palpitations due cardiac dysarrhythmias
• Personality disturbances and/or mood changes
• Symptoms of acute cardiomyopathy^[7]
• Wheezing and dyspnea (due to bronchospasm)
• Electrocardiographic changes that mimic myocardial infarction, or congestive heart failure (decreased cardiac contractility is related to low serum calcium and possibly parathyroid hormone deficiency, as parathyroid hormone receptors are present in cardiac myocytes).^[8][9]