Causes of hypoparathyroidism may include:
(1) following thyroidectomy
(2) due to autoantibodies, which may or may not be associated with the celiac disease
Situations that can arise:
(1) A patient taking calcium and vitamin D supplements may develop hypercalcemia if a gluten-free diet is started and maintained.
(2) Hypocalcemia may develop if there is a worsening of the malabsorption, either due to progression of the celiac disease or occurrence of a second gastrointestinal disorder such as chronic diarrhea.
(3) Serum calcim levels may fluctuate if the patient varies in adherence to various the regimens.
Complications that may develop include:
(1) nephrocalcinosis or kidney stones
(2) metabolic bone disease
(3) renal failure
The serum calcium should be monitored if there is a change in the patient's condition. The frequency of monitoring can be decreased once the patient is stable.
A patient should have both anti-endomysial antibodies and parathyroid hormone levels measured if an unexplained change in calcium concentration occurs, especially if the patient has a history of a bowel disease.
