Chronic hypoparathyroidism is a rare disease that occurs when the body does not produce enough parathyroid hormone (PTH). In a new doctoral thesis from Karolinska Institutet, Wafa Kamal, doctoral student at the Department of Molecular Medicine and Surgery, examines how the disease affects patients' lives in the long term.
What's the main focus of your thesis?
"My thesis focuses on chronic hypoparathyroidism, a rare endocrine disorder that occurs when the body produces an insufficient amount of parathyroid hormone (PTH). The lack of PTH leads to low calcium levels in the blood, which can cause tingling sensations, muscle cramps, fatigue, and, in more severe cases, cardiac arrhythmias or seizures. In most cases, the disease develops after neck surgery in which the parathyroid glands, normally responsible for producing PTH, are damaged or removed. Other causes include autoimmune conditions or inherited disorders. Treatment usually consists of active vitamin D and calcium, which help stabilize calcium levels but do not fully restore the body's natural calcium balance."
"The thesis examines the disease from several perspectives. Using Swedish national health registers, I analyzed the validity of diagnostic codes, the impact of the disease on fracture risk, and its associations with mortality and mental health", says Wafa Kamal , doctoral student in the Experimental and Clinical Neuroendocrinology research group, the Department of Molecular Medicine and Surgery ,, Karolinska Institutet and assistant chief physician at Karolinska University Hospital.
What's the main focus of your thesis?
"My thesis focuses on chronic hypoparathyroidism, a rare endocrine disorder that occurs when the body produces an insufficient amount of parathyroid hormone (PTH). The lack of PTH leads to low calcium levels in the blood, which can cause tingling sensations, muscle cramps, fatigue, and, in more severe cases, cardiac arrhythmias or seizures."
"In most cases, the disease develops after neck surgery in which the parathyroid glands, normally responsible for producing PTH, are damaged or removed. Other causes include autoimmune conditions or inherited disorders. Treatment usually consists of active vitamin D and calcium, which help stabilize calcium levels but do not fully restore the body's natural calcium balance."
"The thesis examines the disease from several perspectives. Using Swedish national health registers, I analyzed the validity of diagnostic codes, the impact of the disease on fracture risk, and its associations with mortality and mental health."
Which are the most important results?
"We demonstrated that the diagnostic codes for hypoparathyroidism in the Swedish National Patient Register are highly reliable. In about nine out of ten cases, the registered diagnoses were consistent with information in patient records, indicating that these data can be used with high precision for research purposes."
"The studies also showed that patients with chronic hypoparathyroidism have an altered fracture risk. They are more likely to experience vertebral fractures but less likely to sustain hip fractures compared with the general population. Despite being more frequently diagnosed with osteoporosis, these patients were less often treated for it, suggesting a potential treatment gap in clinical care."
"The thesis further revealed an increased mortality, particularly among patients with nonsurgical disease. Individuals with chronic hypoparathyroidism also used sedatives, strong analgesics, and antiepileptic medications more often than matched controls, indicating a greater neuropsychiatric burden than is reflected by diagnostic codes alone."
How can this new knowledge contribute to the improvement of people's health?
"My thesis shows that chronic hypoparathyroidism is a complex disease 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."
"The finding of increased mortality among patients with nonsurgical hypoparathyroidism emphasizes the importance of identifying those at greatest risk of complications and determining how such risks can best be prevented. In the long-term, this knowledge may support more individualized management, reduce disease burden, and improve quality of life for people with chronic hypoparathyroidism."
What are your future ambitions?
"My immediate focus is to help establish the Regional Knowledge Center for Osteoporosis at the Department of Endocrinology, Karolinska University Hospital in Huddinge. In parallel, I plan to combine clinical work with continued teaching and research, focusing on both hypoparathyroidism and osteoporosis", says Wafa Kamal.
Dissertation
Friday November 7, 2025 at 09:15 Lilla salen QA31:01, Karolinska vägen 37A, Karolinska University Hospital.
Thesis
Hypoparathyroidism : epidemiological studies from prevalence to mortality
