Parathyroid gland

Dr. Naglaa Atef  

 There are four parathyroid glands
embedded in the posterior surface of
thyoid gland .
 It secretes a polypeptide hormone called
parathormone ( PTH ) .
 This hormone is essential to life .
 It is secreted by certain type of cells
called Chief cells .
 Actions of PTH :

Role of PTH in calcium homeostasis :

• The parathormone is a major regulating factor

for both calcium and phosphate concentrations
in extracellular fluids .
• Normally plasma Po4--- is inversely related to Ca++
and the product of Ca++ Po4--- is called solubility
product constant.
• The main function of parathormone is to ↑ Ca++
level and ↓ Po4--- level so as to maintain the
solubility product constant .
1. On bone :
• PTH stimulates bone resorption
by increasing activity and
formation of osteoclasts ( bone
eating cells ) causing
demineralization of bone so ↑
blood Ca++ level ( due to release of
Ca++ from bone to the blood )
• Vit. D3 is essential for PTH action
on bone .
1. On kidney :
• PTH stimulates Ca++ reabsorption in
distal convoluted tubules so, ↑ blood
Ca++ level .
• It inhibits Po4--- reabsorption in
proximal tubules of kidney so, ↓ blood
Po4--- level .

3. On intestine :
• It increase absorption of Ca++ from the
intestine by increasing formation of
Vit. D3 ( 1,25 DHCC ) .
 Cardiovascular actions of PTH :

• Cardiac hypertrophy
• Increase heart rate
• Vasodilatation of blood vessels ( ↓ blood
pressure , ↑ coronary blood flow , ↑
renal blood flow ) .
 Parathormone receptors :

• Parathormone type 1 receptors :

present in bone and kidney act by ↑
cAMP .
• Parathormone type 2 receptors :
present in the heart , brain , placenta
and vascular smooth muscles .
• It is responsible for cardiovascular
actions of PTH . 
 Control of PTH secretion :

• PTH is not under the control of anterior pituitary .

• It is controlled by -ve feed back mechanisms :

1. increase in Ca++ level inhibit PTH secretion while

the decrease in Ca++ level stimulate PTH
production .
2. 1,25DHCC ( vit. D3 ) : inhibits formation of PTH
3. Plasma Po4--- level : its increase stimulate PTH
secretion .
 Disorders of parathyroid function
1. Hypoparathyroidism

 Causes :
1. The commonest cause is removal of
parathyroid glands with the thyoid gland
during total thyroidectomy for thyroid
carcinoma.
2. Failure of parathyroid gland to secrete PTH
due to autoimmune disorder.
3. Receptor defect : normal PTH level but
fails to stimulate the receptor .
 Clinical picture :

1. Hypocalcaemia : decreased plasma Ca++ level

from normal level ( 10 mg/100ml ) to reach 7
mg/100ml or less , this causes increased
excitability of the nervous system including
neuromuscular junction .
Neuromuscular hyperexcitability leads to
spastic contraction of skeletal muscles called
( Tetany ) which is the main characteristic
feature of hypoparathyroidism.

2. Increase in blood Po4--- ( normal level 4 mg% ) .

 Tetany
 Causes : tetany is a state of spastic
contraction of skeletal muscles caused by
increase in neuromuscular excitability as a
result of decreased ionized plasma Ca++ level
caused by :

1. Hypoparathyroidism
2. Alkalaemia : which promotes binding of
calcium with plasma proteins , so plasma Ca+
+
level is decreased .
***Causes of alkalaemia :
• Hyperventilation
• Vomiting
3. Decreased calcium absorption from GIT due
to :
• Low calcium intake .
• Vit. D deficiency

4. Citrate administration : causes precipitation

of Ca++ e.g. massive blood transfusion in
patient with liver disease ( liver converts
citrate into bicarbonate )
 Type of tetany :
• There are two main types :
1. Manifest tetany
2. Latent tetany

1. Manifest tetany :
In this type plasma Ca++ is less than 7 mg
%
• Clinical picture :

1. Skeletal muscles are stiff specialy in

hands and feet producing Carpopedal
Spasm

2. Spasmodic contraction of laryngeal

muscles leads to cyanosis , if laryngeal
spasm is severe or prolonged, It causes
death due to asphyxia .

3. Muscle contractions and may be

convulsions .
 2. Latent tetany :
• In this type plasma Ca++ reduced but dose not
reach 7 mg % .
• No symptoms are present but it needs certain
tests to be diagnosed (Provocation tests):

1- Chvostek’s sign :
. Taping over facial nerve
in front of the ear ( at the
angle of the jaw ) causes
quick contraction of facial
muscles at the same side
 2. Trousseau’s sign :
• Occlusion of circulation by cuff of a
sphygmomanometer wrapped around
the arm then the pressure is raised
above systolic pressure causes spasm
of muscles of upper limb ( carpal
spasm )
3. Erb’s sign :
• Stimulation of motor nerves by
weak currents ( which normally
produce no effects ) causes
muscle contraction .

4. Estimation of plasma Ca++

level .
 2. Hyperparathyroidism

 Cause : usually tumour in one

parathyroid gland .
 Manifestations :
There is rise of plasma Ca++ and lowering of
plasma Po4--- .

1. Bone :
Excess PTH stimulate osteoclasts ( ↑ its activity )
leading to mobilization of Ca++ from bone ( =
decalcification or demineralization of bone ) with
appearance of multiple cysts in bone :
• Bone pain
• Mild trauma causes fracture
• Spontaneous fractures
• ↓ density in X – ray
2. Hypercalcaemia :
Causes :
• Depression of nervous system
• Muscle weakness
• Constipation
• ↓ appetite ( due to ↓ GIT motility )

3. Deposition of Ca++ in soft tissues :

• In kidney.
• In lungs .
• In arterial wall .
4. Formation of Renal stone

5- Polyuria:
due to increase Ca++ excretion in urine
(hypercalcuria )
Despite ↑ Ca++ reabsorption from kidney
by ↑↑ PTH
there is also hypercalcuria due to
excessive Ca++ filtration as a result of
severe hypercalcaemia .