Parathyroid Gland and Hyperparathyroidism

• These small glands, usually four, surround the posterior thyroid tissue.
• Parathyroid glands produce parathormone (PTH) in response to low blood calcium levels.
• PTH raises blood calcium levels by increasing reabsorption from the kidney, intestine, and bones.

Hyperparathyroidism

• Excessive production of parathyroid hormone leads to bone decalcification and renal calculi containing calcium.
• Primary hyperparathyroidism typically occurs after age 60 and is more common in women, often due to adenoma or hyperplasia.
• Secondary hyperparathyroidism is often caused by chronic kidney failure leading to phosphorus retention and increased parathormone secretion.
• Clinical manifestations include fatigue, muscular weakness, apathy, height loss, frequent fractures, and renal stones.
• Other symptoms: anorexia, nausea, abdominal discomfort, constipation, back and joint pain, hypertension, and cardiac arrhythmias.
• Memory impairment, nephrolithiasis, kidney damage, musculoskeletal symptoms, peptic ulcer, and pancreatitis can also manifest.
• Diagnostic evaluation involves assessing increased serum calcium levels, decreased serum phosphate levels, and hypercalciuria.
• X-rays may show weak, porous bones, and blood tests can reveal elevated parathyroid hormone levels.
• Ultrasound, MRI, and fine needle biopsy can be used to evaluate parathyroid hormone function.

Medical Management of Hyperparathyroidism

• Parathyroidectomy involves surgical management.
• Hydration therapy encourages increased fluid intake to prevent kidney stones.
• Patients are encouraged to maintain mobility through walking.
• Regular monitoring of symptoms is necessary.
• Dietary and medication management includes avoiding diets with restricted or excess calcium, using antacids, and protein feeding.
• Prune juice, stool softeners, physical activity, and increased fluid intake can relieve constipation associated with anorexia.

Hypoparathyroidism

• Endocrine disorder where the parathyroid glands do not produce enough parathyroid hormone (PTH).
• Causes can include abnormal parathyroid development, destruction of the parathyroid gland, or surgical removal during thyroidectomy or neck surgery.
• Autoimmune disorders or Vitamin D deficiency can also lead to hypoparathyroidism.
• Deficiency of parathyroid hormone can lead to hyperphosphatemia (increased blood phosphate level).
• It may also lead to hypocalcemia (decreased blood calcium level), decreased intestinal absorption of dietary calcium.
• Decreased resorption of calcium from bone and through renal tubules are clinical consequence.
• Clinical manifestations include irritability of the neuromuscular system and tetany (muscular hypertonia, numbness, tingling, cramps in extremities, stiffness of hands and feet).
• Overt tetany can lead to bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, photophobia, cardiac dysrhythmias, and seizures.
• Other symptoms: anxiety, irritability, depression, delirium, ECG changes, and hypotension.

Assessment and Diagnostic Findings of Hypoparathyroidism

• Positive Chvostek sign or positive Trousseau sign indicates tetany
• Low serum calcium and increased serum phosphate levels are found in laboratory studies.
• X-rays of bone show increased density.

Medical Management of Hypoparathyroidism

• Goal: increase serum calcium to 9 to 10 mg/dl.
• Treat the underlying cause.
• Administer combination of calcium, magnesium, and ergocalciferol.
• If tetany is present, administer intravenous calcium gluconate, and sedatives if neuromuscular irritability and seizure activity persist.
• Provide an environment free of noise, drafts, bright lights, or sudden movements.
• Frequent monitoring of blood calcium levels is essential.
• High calcium and low phosphorus diets are recommended.
• Heart rate should be monitored regularly.
• A tracheostomy may be necessary if patient develops respiratory distress.
• While milk and egg yolks are high in calcium, they are restricted due to their high phosphorus content.
• Avoid coffee and other stimulants.

Nursing Management of Hypoparathyroidism

• Care for post-operative patients undergoing thyroidectomy or neck dissection includes early detection of hypocalcemia and anticipation of tetany, seizures, and respiratory difficulties.
• Administer calcium gluconate slowly and cautiously, as it increases systolic contraction.
• Patient education about medications and diet therapy focuses on high calcium and low phosphate intake.
• Aluminum carbonate can be given with meals to bind phosphate and promote excretion through the GI tract.