PARATHYROID GLAND

Parathyroid glands are four small glands of the endocrine system which regulate the calcium in our
bodies. Parathyroid glands are located in the neck behind the thyroid where they continuously monitor
and regulate blood calcium levels by producing hormones called parathyroid Hormones (PTH) . Calcium
is the most important element in our bodies (we use it to control many organ systems), so calcium is
regulated more carefully than any other element. In fact, calcium is the only element with it's own
regulatory system -- the parathyroid glands.

Causes (RISK FACTORS)

A noncancerous (benign) growth, called an adenoma, forms on a single parathyroid gland. The
adenoma causes the gland to overact and make more PTH. This is the most common cause. Two or
more of your parathyroid glands become enlarged, a condition called hyperplasia, and produce too
much hormone.

ASSESSMENT FINDING (CLINICAL MANIFESTATION)

The patient may have no symptoms or may experience signs and symptoms resulting from involvement
of several bodysystems. Apathy, fatigue, muscle weakness, nausea, vomiting, constipation,
hypertension, and cardiac dysrhythmias may occur. All these signs and symptoms are attributable to the
increased concentration of calcium in the blood. Psychological effects may vary from irritability and
neurosis to psychoses caused by the direct action of calcium on the brain and nervous system. An
increase in calcium produces a decrease in the excitation potential of nerve and muscle tissue.

DIAGNOSIS TEST

BLOOD TEST:

√ Elevated PTH (Normal serum values for PTH are 10 - 55 picograms per milliliter (pg/mL)

√ Elevated serum calcium >10mg/dl

√ Lowered phosphorus <10mg/dl2.

BONE MINERAL DENSITY TEST (BONE DENSITOMETRY). The most common test to measure bone
mineral density is dual energyX-ray absorptiometry, or a DXA scan. This test uses special X-ray devices to
measure how many grams of calcium and other boneminerals are packed into a segment of bone.

URINE TESTS. A 24-hour collection of urine can provide information on how well your kidneys function
and how much calcium is excreted in your urine. This test may help in judging the severity of
hyperparathyroidism or diagnosing a kidney disorder causing hyperparathyroidism.

ULTRASOUND. A small device held against your skin (transducer) emits high-pitched sound waves and
records the sound wave echoesas they reflect off internal structures. A computer converts the echoes
into images on a monitor.
SESTAMIBI SCAN. Sestamibi is a specially designed radio active compound that is absorbed by
overactive parathyroid glands and can be detected on computerized tomography (CT) scans. A small
dose of the compound is injected into your bloodstream before the imaging test is done.

TREATMENTS AND MEDICATIONS (DEPEND ON THE CAUSE):

Parathyroidectomy: main treatment for primary hyperparathyroidism

✓Monitor respiratory status due to nature of surgery, Semi-Fowler’s position, trach kit, oxygen, and
suction at bedside for emergency

✓Watch for low calcium levels: tingling or numbness or excessive twitching in extremities or face,
tetany, positive Trousseau’s or Chvostek’s Sign

✓ Monitor patient for laryngeal nerve damage: voice changes (hoarseness), problems swallowing or
speaking

Medication Goals: to decrease parathyroid and calcium levels and keep patient hydrated

✓IV fluids: normal saline for hydration

• Calcimimetics: “Senispar” decreases PTH, calcium, and phosphate levels (usually prescribed for
patients with secondary hyperparathyroidism with CKD…patients with renal failure struggle with high
phosphate levels so this medication helps with this as well)

- It mimics the role of calcium in the blood and deceives the parathyroid gland into thinking there is
enough calcium in the blood so it will quit secreting PTH. Note: Take with food or right after meal….side
effects: GI issues and hypocalcemia

• Calcitonin (injection or nasal sprays): naturally produced by the thyroid gland and helps lower calcium
levels (suppresses osteoclast activity of the bones (helps protect bones) and increases the kidneys
excretion of calcium).

• Loop diuretics “Lasix”: decreases calcium levels by inhibiting calcium reabsorption in the renal tubules
(watch potassium levels)

• Bisphosphonates: “Pamidronate (Aredia) or Alendronate (Fosamax)” helps protect bones from losing
calcium by slowing down osteoclasts (which break down bones) and allow osteoblasts to work (to help
build bones)

NURSING DIAGNOSIS

 Activity in tolerance related to fatigue and depressed cognitive process.

  Risk for imbalanced body temperature related to cold intolerance.
 Disturbance through process related to depressed metabolism and altered cardiovascular and
respiratory status .

NURSING INTERVENTION:

Independent

- Adjust activities and reduce intensity level.

- Provide positive atmosphere, while acknowledging the difficulty of situation for the client.

- Assist patients with activities/monitor clients use of assistive device such as walker.

Dependent:

- Parathyroidectomy

- Furosemide (Lasix) 20–40 mg IV bid –qid1.

RATIONALE

• To preventoverexcertion.

• Helps minimize frustration,rechanneling of energy.

• To protect client from injury.

• To remove cause of hyper secretion of parathormones.

References:

Twelfth Edition

Copyright © 2010 by Wolters Kluwer Health / Lippincott Williams & Wilkins.Copyright © 2008 by
Lippincott Williams & Wilkins, a Wolters Kluwer business. Copyright © 2004, 2000 by Lippincott Williams
& Wilkins. Copyright © 1996 by Lippincott-Raven Publishers. Copyright © 1992, 1988, 1984, 1980, 1975,
1970,

1964 by J. B. Lippincott Company

- Medication Guide Fosamax Tablets. 1st ed. Food and Drug Administration, 2013. Web. 26 July 2016.
-“Primary Hyperparathyroidism | NIDDK”. National Institute of Diabetes and Digestive and Kidney
Diseases. N.p., 2012. Web. 26 July. 2016.