Background <p>Hypoparathyroidism is a chronic endocrine disorder requiring lifelong management, with real-world data on the impact of follow-up setting on biochemical and clinical outcomes remaining limited. This study aimed to evaluate real-world management of hypoparathyroidism and to investigate whether endocrinology specialist follow-up is associated with improved biochemical control and clinical outcomes.</p> Methods <p>This retrospective, single-center study included 186 patients with hypoparathyroidism categorized by follow-up setting (endocrinology vs. non-endocrinology clinics). Demographic, biochemical, and clinical data were collected. The primary outcome was achievement of target serum calcium levels (lower-normal or slightly below-normal range per current guidelines). Multivariate logistic regression was performed to identify independent predictors of target calcium achievement, adjusted for age, sex, eGFR, PTH, treatment doses, and serum 25(OH)D.</p> Results <p>The mean age of the cohort was 49.5 ± 12.0 years, 78.5% were female and 82.3% had postsurgical hypoparathyroidism. Overall, 76.3% of patients achieved target serum calcium levels; while target phosphate and 25(OH)D levels were achieved in only 45.2% and 46.9%, respectively.Patients followed by endocrinology specialists demonstrated significantly higher rates of target calcium (96.3% vs. 60.6%, p&lt;0.001), phosphate (53.7% vs. 38.5%, p=0.039), and 25(OH)D achievement (57.3% vs. 29.2%, p=0.002) compared with those followed in non-endocrinology settings. Daily calcium supplementation and calcitriol doses were comparable between groups. Guideline-recommended monitoring, including 24-hour urinary calcium and serum 25(OH)D assessment, as well as complication screening, was performed significantly more frequently in the endocrinology group (all p&lt;0.001). In multivariate analysis, non-endocrinology follow-up was independently associated with lower odds of target calcium achievement (OR: 0.08, 95% CI: 0.02–0.33, p&lt;0.001), while serum 25(OH) D was a positive predictor of target calcium achievement (OR: 1.12, 95% CI: 1.01–1.23, p=0.030). The model demonstrated adequate goodness-of-fit (Hosmer–Lemeshow p=0.127).</p> Conclusions <p>Follow-up by endocrinology specialists is independently associated with improved biochemical control in patients with hypoparathyroidism, an effect not explained by differences in medication doses. These findings suggest that specialist follow-up may play an important role in optimizing biochemical target achievement and long-term disease management and support the integration of endocrinology specialist care as a standard component of routine clinical practice in hypoparathyroidism.</p>