Are Patients with Hypoparathyroidism More Susceptible to COVID 19?


The coronavirus disease, COVID-19, has placed a significant impact on healthcare systems globally. This pandemic situation not only disrupt the delivery of emergency care, but knock-on consequences have resulted in major delays to the delivery of elective care, including surgery.

  • COVID-19 has impacted in the management of hypoparathyroidism and hyperparathyroidism. The existing evidence reveals no link suggestive of patients with hypoparathyroidism being more likely to contract the SARS-CoV-2 virus or have worse outcomes. However, there are factors associated with hypoparathyroidism, which have been shown to increase the likelihood of infection.

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  • Parathyroid hormone (PTH) plays a key role in the conversion of 25-hydroxyvitamin D to its active form. Individuals with hypoparathyroidism (lacking PTH) have reduced conversion of vitamin D precursors to their active forms, so supplementation with active vitamin D is central to the management of the condition (J.P., 2016). A systematic review and meta-analysis of various randomized controlled trials (RCTs) concluded that vitamin D supplementation lowered the risk of acute respiratory tract infection (Martineau, et al., 2017). Another review suggested that high-dose vitamin D supplementation may help lower the risk of contracting certain viral respiratory tract infections (Grant, et al., 2020).
  • It is important that avoidance of clinically apparent c is a central treatment aim in the management of hypoparathyroidism. Severe hypocalcemia can be precipitated by viral infection in patients with hypoparathyroidism. A study has highlighted the underlying mechanisms behind severe COVID-19 infection and hypocalcemia. Patients severely affected by COVID-19 have higher levels of unbound and unsaturated fatty acids (Singh, 2020). The high levels of unsaturated fatty acids can precipitate a cytokine storm and also bind calcium, leading to reduced calcium levels (Aojula N., 2021).

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  1. Bilezikian, J.P.; Brandi, M.L.; Cusano, N.E.; Mannstadt, M.; Rejnmark, L.; Rizzoli, R.; Rubin, M.R.; Winer, K.K.; Liberman, U.A.; Potts, J.T., Jr. Management of Hypoparathyroidism: Present and Future. J. Clin. Endocrinol. Metab. 2016, 101, 2313–2324.

  2. Martineau, A.R.; Jolliffe, D.A.; Hooper, R.L.; Greenberg, L.; Aloia, J.F.; Bergman, P.; Dubnov-Raz, G.; Esposito, S.; Ganmaa, D.; Ginde, A.A.; et al. Vitamin D supplementation to prevent acute respiratory tract infections: Systematic review and meta-analysis of individual participant data. BMJ 2017, 356, i6583.

  3. Grant, W.B.; Lahore, H.; McDonnell, S.L.; Baggerly, C.A.; French, C.B.; Aliano, J.L.; Bhattoa, H.P. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients 2020, 12, 988.

  4. Singh, V.P.; Khatua, B.; El-Kurdi, B.; Rood, C. Mechanistic basis and therapeutic relevance of hypocalcemia during severe COVID-19 infection. Endocrine 2020, 70, 461–462.

  5. Aojula, N.; Ready, A.; Gittoes, N.; Hassan-Smith, Z. Management of Parathyroid Disease during the COVID-19 Pandemic. J. Clin. Med. 2021, 10, 920.

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