Hypoparathyroidism

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Hypoparathyroidism is an endocrine disorder characterized by insufficient parathyroid hormone activity, resulting in hypocalcaemia and multisystemic effects.

It can present with psychiatric features such as depression, anxiety, irritability, cognitive impairment, apathy, behavioural change, and, rarely, psychosis. Such manifestations have been reported particularly in the setting of chronic or severe hypocalcaemia and intracranial calcification, although the causal mechanisms are not fully established.

Other characteristic features include neuromuscular irritability with paresthesias, muscle cramps, carpopedal spasm and tetany, as well as seizures. Chronic disease may be associated with cognitive impairment and, in some patients, intracranial calcification with movement disorders.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Cardiovascular: prolonged QT interval and cardiac arrhythmias may occur with significant hypocalcaemia; severe cases may rarely cause impaired cardiac function.

  • Respiratory: laryngospasm and, less commonly, bronchospasm may occur during significant hypocalcaemia.

  • Renal/electrolytes: hypocalcaemia and hyperphosphataemia are characteristic biochemical abnormalities; hypercalciuria, nephrolithiasis, nephrocalcinosis, and renal impairment may occur, particularly during long-term treatment.

  • Endocrine: hypoparathyroidism may occur as part of autoimmune polyglandular syndromes, particularly when associated with other autoimmune endocrine disorders.

  • Musculoskeletal: muscle cramps, stiffness, muscle spasms, and tetany are characteristic manifestations of hypocalcaemia.

  • Dermatologic: dry skin, coarse hair, brittle nails, and alopecia may occur, particularly with chronic hypocalcaemia.

Early diagnosis is important to identify and correct hypocalcaemia, prevent potentially serious neurological and cardiac complications, reduce the risk of chronic renal and skeletal complications, identify associated autoimmune disease where relevant, and improve potentially reversible neuropsychiatric symptoms and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.