A recent doctoral thesis from the Karolinska Institutet reveals significant insights into the long-term effects of chronic hypoparathyroidism, a rare endocrine disorder characterized by insufficient production of parathyroid hormone (PTH). Conducted by Wafa Kamal, a doctoral student at the Department of Molecular Medicine and Surgery, the research highlights the condition’s impact on patients’ health and quality of life.
Chronic hypoparathyroidism occurs when the body fails to generate adequate PTH, leading to dangerously low levels of calcium in the blood. This deficiency can result in a range of symptoms, including tingling sensations, muscle cramps, fatigue, and in severe cases, cardiac arrhythmias or seizures. The disorder frequently develops following neck surgeries that damage or remove the parathyroid glands, with other causes including autoimmune diseases and genetic disorders. Current treatment typically involves active vitamin D and calcium supplements to stabilize calcium levels, though these do not fully restore the body’s natural balance.
Kamal’s research adopts a multi-faceted approach, utilizing data from Swedish national health registers to investigate various aspects of the disease. “The thesis examines the disease from several perspectives. I analyzed the validity of diagnostic codes, the impact of the disease on fracture risk, and its associations with mortality and mental health,” she stated.
The findings underscore the reliability of the diagnostic codes for hypoparathyroidism in the Swedish National Patient Register. Approximately 90% of registered diagnoses were consistent with patient records, confirming the data’s precision for research purposes.
Additionally, the research identified that patients with chronic hypoparathyroidism face unique fracture risks. While they have a higher likelihood of experiencing vertebral fractures, they are less prone to hip fractures compared to the general population. Despite a higher incidence of osteoporosis diagnoses, these patients receive treatment less frequently, indicating a potential gap in clinical care.
The thesis also revealed an increased mortality rate among patients with nonsurgical hypoparathyroidism. Those affected tend to use sedatives, potent analgesics, and antiepileptic medications more often than matched controls, suggesting a significant neuropsychiatric burden that is not fully captured by diagnostic codes.
Kamal emphasized that her research illustrates chronic hypoparathyroidism as a complex condition affecting multiple organ systems and associated with serious health consequences. “It contributes new knowledge that deepens our understanding of the condition and highlights the need for further studies to evaluate whether structured long-term follow-up or revised treatment strategies could improve care for these patients,” she explained.
The findings regarding increased mortality among nonsurgical patients highlight the necessity of identifying individuals at higher risk for complications and exploring effective prevention strategies. Such knowledge could facilitate more individualized management, thereby alleviating the disease burden and enhancing the quality of life for those with chronic hypoparathyroidism.
Moving forward, Kamal intends to support the establishment of the Regional Knowledge Center for Osteoporosis at the Department of Endocrinology at Karolinska University Hospital in Huddinge. She plans to balance her clinical responsibilities with ongoing teaching and research, concentrating on hypoparathyroidism and osteoporosis.
A public presentation of her findings is scheduled for November 7, 2025, at 09:15 in Lilla salen QA31:01, Karolinska vägen 37A, Karolinska University Hospital.
