PARATHYROID DISORDERS

I.

HYPERPARATHYROIDISM
- Is a disorder caused by over
activity of one or more of the
parathyroid glands

Classified as:
1.) Primary develops when the
normal regulatory rel.
between serum calcium
levels and parathyroid
hormone secretion is
interrupted
- Occurs when an adenoma or
hyperplasia of the gland
exists
2.) Secondary occurs when
the glands are hyperplastic
bc of malfunction of another
organ system.
- Usually result of renal failure
but may also occur as result
of cancers
3.) Tertiary occurs when PTH
production is irrepressible
(autonomous) in clients with
normal or low serum calcium
levels.
Patho:

Fractures of the spine, ribs,

long bones
Deformity and bending of the
bones
Osteitis fibrosa or radiologic
osteoporosis
Polyuria and polydipsia
Appearance of sand, gravel
or stones (calculi) in the
urine; azotemia
Hypertension
Fatal renal hypertension
Uremia
Thirst, nausea, anorexia,
constipation, ileus, abd. Pain
Decreased neuromuscular
irritability
Depression, paranoia
Dehydration, hypocalcemia,
GI problems

Laboratory findings:
-

Serum calcium levels are

elevated
Serum phosphate levels are
depressed
Both urine calcium and urine
phosphorus levels are high
Alkaline phosphate level is
elevated

Medical Mngt:
-

Normal fxn of PTH is to

maintain proper balance of
calcium and phosphorus ions
in the blood
Hypercalcemia

Manifestations:
-

May be asymptomatic
Skeletal dse
Renal involvement
GI tract disorders
Neurologic abnormalities
Back ache, joint pain, bone
pain

Lowering severly elevated

calcium levels.
Long term management of
hypercalcemia
Serum calcium levels are
lowered by hydration and
calciuria.
Infusion of NSS

Meds:
Furosemide loop diuretic used to promote
calciuria after rehydration has occurred.

Plicamycin a chemotherapeutic drug that

is effective in lowering serum calcium levels.

Gallium nitrate
Glucocorticoids used to reduce
hypercalcemia by decreasing the GI
absorption of calcium.
Etidronate or Calcitonin used to decrease
release of calcium by bones
Nsg Mngt:
-

Thorough history
Encourage fluids; client
should consume at least
3000mL of fluid each day
Dehydration is dangerous
in clients
Prevent Urolithiasis;
Cranberry juice or Prune
juice may help make the
urine more acidic.
Acidification helps to
prevent renal stone
formation
Strain urine of stones

Surgical Mngt:
-

Definitive tx of primary
hyperparathyroidism is
surgical removal of the gland
causing hypersecretion of
PTH.
After partial
parathyroidectomy it is
possible to transplant
remaining healthy
parathyroid tissue to a safer
location such as the
brachioradial muscle of the
forearm.

Nsg mngt for surgical pt:

II.

Renal fxn should be carefully

assessed preoperatively.
Administer Digitalis;
administer with extreme
caution.
Mild tetany resulting from a
drop in the serum calcium
level is expected after
removal

HYPOPARATHYROIDISM
- Hyposecretion of the
parathyroid glands
- Serum calcium levels are
abnormally low
- Serum phosphate levels are
abnormally high
- Neuromuscular irritability
(tetany) may develop

Risk factors:
Causes may be:
1.) Iatrogenic (tx-induced) causes
include accidental removal of
parathyroid glands
- Infarction of the parathyroid
glands bc of an inadequate
blood supply to the glands
during surgery
- Monitor PTH, calcium,
phosphorus levels
- CALCIUM SUPPLEMENTS
are needed for life to orevent
tetany
2.) Idiopathic (without specific
cause) Graves dse and
Hashimotos, it may be an
autoimmune disorder with
genetic basis.
- Pseudohypoparathyroidism;
is an inherited form of
hypoparathyroidism that
involves a lack of end-organ
responsiveness to PTH.

Patho:
-

PTH acts to increase bone

resorption

Manifestation:
-

Low serum calcium levels

More severe in pts with an
elevated serum pH
(alkalosis)

Lab findings for diagnosis:

Low calcium level
Low PTH level
High phosphorus level
Decreased urine calcium
level
CT scan
Ophthalmic examination
Complication:

Acute hypo:
-

Caused by accidental
damage to parathyroid
tissues during thyroidectomy
Charcd by greatly increased
neuromuscular irritability
which results to tetany.
Assessment also reveals
CHvosteks and Trousseaus
signs
Some cases tetany is so
severe that a tracheostomy is
required

Chronic Hypo:
-

Medical Mngt:
Acute hypopara is a life-threatening
disorder
Chronic hypopara desired outcome of
intervention is to restore the serum calcium
level to normal
Meds:

Usually idiopathic resulting in

lethargy, thin, patchy hair,
brittle nails, dry scaly skin
and personality changes.
Ectopic or unexpected
calcification may appear in
the eyes and basal ganglia

Oral calcium salts

(calcium gluconate)
Vitamin D
Client with hypopara should receive a diet
high in calcium but low in phosphorus
Nsg Mngt for pt in meds:
-

Diagnosis of hypoparathyroidism is based

on:
1.)
2.)
3.)
4.)
5.)

If tx is not started rapidly in

acute hypopara, DEATH can
result from the respi
obstruction secondary to
tetany and laryngiospasm

Chvosteks sign
Trouseaus sign
Hyperactive deep tendon reflexes
Circumoral paresthesia
Numbness and tingling of fingers

Question pt for numbness or

tingling around mouth,
fingertips, toes
Check for chvostek and
trousseaus signs
Assess for respi distress

Chronic hypopara:
-

Assess for obvious physical

changes such as skin, hair

Assess for parkinsonian

syndrome or cataracts
Assess the teeth

Interventions:
-

Prevent respi arrest

Monitor and prevent tetany