Clinical scenario: Permanent impairment typically arises after surgical removal of the parathyroid glands.
Parameters:
(1) hypocalcemia and response to therapy
(2) signs and symptoms
Signs and symptoms:
(1) Chvostek's sign (contraction of facial muscles induced by light tapping of the facial nerve)
(2) Trousseau's sign (carpopedal spasm seen after placing a blood pressure cuff on the forearm and raising the pressure above the systolic blood pressure)
(3) tetany
(4) perioral and/or peripheral paresthesia
(5) muscular irritability, often worsened by exercise
(6) prolongation of QT interval on ECG
(7) laryngospasm
(8) generalized convulsions
(9) encephalopathy with dementia or psychosis
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Hypocalcemia
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Symptoms
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Impairment of the Whole Person
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minimal, no therapy required
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none
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0%
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therapy effective
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none with therapy
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0 - 9%
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partially effective
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symptomatic despite therapy
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10 – 20%
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where:
• A person with severe hypoparathyroidism would have more than 20% whole person impairment; however, many of the serious complications (encephalopathy, seizures, etc.) would be transient rather than permanent. The degree of impairment here needs to be combined with any long-term neurologic impairment.
