HYPERPARATHYROIDISM

AND HYPOPARATHYROIDISM

SWETA SINGH
M.Sc NURSING 1ST YR.
 PARATHYROID GLAND
 The parathyroid glands are
situated in the neck and
embedded in the posterior
aspect of the thyroid gland.

 Parathormone (parathyroid
hormone) – the protein hormone
produced by the parathyroid
glands, which regulates calcium
and phosphorus metabolism.
 Cont.

 Increased secretion of PTH results in increased

calcium absorption from the kidney, intestine, and
bones, which raises the serum calcium level. Also
increased by the presence of VIT D. it also lowers
the blood phosphorus level. Increased serum
calcium results in decreased PTH secretion, creating
a negative feedback system.
HYPERPARATHYROIDISM
 Cont.
 Hyperparathyroidism is caused by overproduction
of Parathormone by the parathyroid glands and is
characterised by bone decalcification and the
development of renal calculi containing calcium.

 It usually occurs in clients older than 60 and affects

women twice as often as men. Its incidence is
approximately 25 cases per 1, 00,000 people.
 ETIOLOGY

 Primary hyperparathyroidism:

In this parathyroid gland inappropriately making too much

Parathormone.
 Parathyroid adenoma
 Multiple benign tumor
 Parathyroid over activity
 Multiple endocrine neoplasm
 Secondary hyperparathyroidism:

In this appropriate secretion of parathyroid gland but

due to hypocalcaemia it increases Parathormone.
E.g. VIT D deficiency, chronic renal failure, Paget’s
disease.
 CLINICAL MANIFESTATIONS

CARDIOVASCULAR
GASTROINTESTINAL MUSCULOSKELETAL
SYSTEM
• hypertension • Pancreatitis • Bone pain
• Dysrhythmia • cholelithiasis • Backache
• Hypercalcemia • Peptic ulcer • Fatigue
• hypophosphatemia • Anorexia • Muscle weakness
• Constipation • Osteoporosis
• Abdominal pain • fracture
Cont.

NERVOUS
RENAL SYSTEM
SYSTEM
• Renal stone • lethargy
• UTI • Fatigue
• Hypercalciuria • Depression
• polyurea • confusion
DIAGNOSTIC EVALUATION
PATHOPHYSIOLOGY
 MANAGEMENT

1. Lower elevated calcium levels

Can be lowered by hydration and calciuria. Hydration can be maintain
with NS infusion, it both expand the volume and acts in the kidney to
inhibit the resorption of calcium. Lasix may also used to promote
calciuria after hydration is occurred.
Thiazide diuretics are not used because they promote calcium retension.
 Cont.

2. Antiresorption agents
Drugs that inhibit bone resorption inlude
plicamycin(mithracin), gallium nitrate, phosphates,
and calcitonin. Plicamycin is a chemotherapeutic
drug that is effective in lowering serum calcium
levels.
glucocorticoids may be used to reduce
hypercalcemia by decreasing the gastrointestinal
absorption of calcium.
 SURGICAL MANAGEMENT

 Parathyroidectomy (post-operative management)

• Monitor for respiratory distress
• Place a tracheostomy set, oxygen supplement, suction
equipment at the bed side.
• Check vital sign
• Semi-fowlers position
 Cont.

• Assess neck dressing for bleeding.

• Monitor for hypocalcemic crisis. E.g., Tingling
and twitching in face and extremities.
• Assess for trousseau’s sign and chvostek sign.
• Assess for changes in voice, monitor for
laryngeal nerve damage.)
• Administer vitamin D supplements.
 NURSING MANAGEMENT

1. Monitor vitals and blood pressure.

2. Monitor cardiac contractibility.
3. Monitor cardiac arrhythmia.
4. Maintain for skeletal pain.
5. Maintain I/O chart.
6. Moderate calcium and high fiber diet.
 DIETARY MANAGEMENT

1. Patients are advised to avoid a diet with restricted or

excess calcium.
2. If patient is having coexisting peptic ulcer, prescribe
antacids and protein feeding are necessary.
3. Prune juice, increased fluid intake helps offset constipation
which usually occurs postoperatively.
COMPLICATIONS
 Cont.
 HYPERCALCEMIC CRISIS

 Acute hypercalcemic crisis can occur with extreme

elevation of serum calcium levels. Serum calcium
level greater than 13mg/dl result in neurologic,
cardiovascular and kidney symptoms that can be life
threatening.
 Rapid rehydration with large IV isotonic saline fluid
to maintain urine output of 100-150 ml per hour is
combined with administration of calcitonin.
 
HYPOPARATHYROIDISM
 Cont.

In hypoparathyroidism serum calcium levels are

abnormally low and serum phosphate level is high,
and pronounced neuromuscular irritability (tetany)
may develop.
Hypoparathyroidism is commonly diagnosed in
women rather than men.
  
ETIOLOGY

 Idiopathic
 Iatrogenic (accidental removal of
the parathyroid gland during
thyroidectomy, infarction of the
parathyroid gland because of an
inadequate blood supply to the
gland during surgery by post-
operative tissue.)
 Pseudohypoparathyroidism
 Pseudohypoparathyroidism is an inherited
form of hypoparathyroidism that involved a
lack of end-organ responsiveness to
hypoparathyroidism.
 Characterized by a peripheral resistance to
parathyroid hormone rather than a deficiency,
 Hypocalcaemia, hyperphosphatemia, raised
serum PTH.
 TYPES OF
HYPOPARATHYROIDISM

 Acute hypoparathyroidism
Acute hypoparathyroidism is caused by accidental removal or
damage of the parathyroid gland during thyroidectomy.
 

 Chronic hypoparathyroidism
Chronic hypoparathyroidism is usually Idiopathic.
 CLINICAL MANIFESTATION
 Symptoms of acute hypoparathyroidism
1. Neuromuscular irritability (which result in tetany.).
2. In tetany patient may experience.
3. Painful muscle spasm.
4. Irritability.
5. grimacing.
6. tingling of the fingers.
7. laryngospasm
8. dysrhythmias.
 Symptoms of chronic hypoparathyroidism

1. Lethargy
2. Thin
3. Patch hair and Brittle nails
4. Dry and scaly skin and personality changes
5. Unexpected calcification may appear in the eyes and basal
ganglia. Thus, cataracts and permanent brain damage
accompanied by psychosis or convulsion may develop.
6. Hypocalcemia adversely affects the heart causing
dysrhythmias and eventual cardiac failure.
 DIAGNOSTIC EVALUATION

 Positive chvostek’s sign (when a sharp tapping over the facial nerve
just in front of the parotid gland and anterior to the ear causes spasm
or twitching of mouth, nose, and eye.)
 Positive trouseau’s sign (when carpopedal spasm is induced by
occluding the blood flow to the arm for 3 minutes with blood
pressure cuff).
 Blood investigation like serum calcium level which will be very low,
serum phosphorus level will be increased.
 X-ray of bone show increased density.
 PATHOPHYSIOLOGY
DECREASED PTH
SECREATION
HYPERPHOSPHATEMIA HYPOCALCEMIA

DECREASED INTESTINAL ABSORPTION

DECREASED RENAL EXCREATION OF OF DIETARY CALCIUM AND DECREASES
PHOSPHATE CAUSES RESORPTION OF CALCIUM FROM BONES
THROUGH RENAL TUBULES

LOW SERUM CALCIUM LEVEL RESULT

HYPOPHOSPHATURIA
IN HYPERCALCIUREA
 MANAGEMENT

 MEDICAL MANAGEMENT
1. Elevate serum calcium level.
To elevate serum calcium level quickly, 10% calcium
gluconate may administer IV.
while administering the calcium gluconate, instruct the
patient to inhale CO2 by breathing into a paper bag.
CO2 inhalation causes a mild metabolic acidosis, which
elevates the ionized calcium in the blood.
2. Oral calcium replacement
The patient with chronic hypoparthyroidism is to keep the
patient asymptomatic with a serum calcium level upto
8.5mg/dl.
oral calcium salt(tab shelcal) can given to the patient.

3. Vitamin D
Commercially available forms of vitamin D include
ergocalciferol, dihydrotachysterol and
droxycholecalciferol. All these three form of vitamin D are
effective in correcting hypocalcaemia. They are available
as either tablets or oily liquids.
 Cont.

4. Parathyroid hormones
the ideal treatment of parathyroid hormone deficient
condition is replacement of the hormones.

5. High calcium and low phosphate diet

A diet high in calcium but low in phosphorus needs vitaminD
rich diet to maintain serum calcium levels.
 NURSING MANAGEMENT

 Carefully assess the patient for development of hypocalcaemia.

 Frequently asked patient about any numbness or tingling around the

mouth or in the finger tips or toes.

 Check the Chvostek’s and trousseau’s signs.

 Check for any respiratory distress and secondary to laryngospasm.

 Assess for Parkinson’s-like syndrome or cataracts.

 Assess the teeth because pits may encircle them, indicating enamel
hypoplasia .
 Cont.
 Care of postoperative patients with parathyroidectomy, and
radical neck dissection is directed toward detecting early signs
of hypercalcemia and anticipating signs of tetany, seizures, and
respiratory difficulties.

 Calcium gluconate is kept at the bedside.

 Calcium and digitalis increase systolic contraction and also

potentiate each other; this may produce potentially fatal
dysrhythmia. Consequently, the cardiac patient requires
continuous cardiac monitoring and careful assessment.
 DIETARY MANAGEMENT
 Teach the patient about medications and diet therapy. patient should
know contact immediately to the physician if any symptoms occur.

 Teach patient about a diet in calcium but low in phosphorus. Remind

patient about omit cheese and milk products which have high
phosphorus content.

 Instruct the patient to have serum calcium levels checked by

physician at least three times a year
 COMPLICATIONS

 If the treatment not started rapidly in acute

hypoparathyroidism, death can result from the respiratory
obstruction secondary to tetany and laryngospasm.

 In chronic hypoparathyroidism, the complications are

calcification in the eyes and basal ganglia
 HEALTH EDUCATION

 For hyperparathyroidism
 Avoid excessive loss of body fluids(eg. Dehydration), prolonged bed
rest or inactivity, and a high calcium diet since these can increase
blood calcium levels.
 Minimize bone loss by remaining active.
 Drink an adequate amount of fluid throughout the day. This may help
to minimize the risk of kidney stones.
 Maintain a moderate calcium intake (approx 1000mg of elemental
calcium/day.)
 Consume moderate amount of vitamin D (400 to 600 IU). VIT D
deficiency can stimulate PTH secretion and bone resorption.
 Cont.
 For hypoparathyroidism

 Calcium rich diet should be taken that is dairy products, green leafy
vegetables, broccoli etc.
 Low in phosphorus rich diet.
 Monitor how much calcium and vit D you get in your diet.
 
SUMMARY
 CONCLUSION
HYPERPARATHYROIDIS
HYPOPARATHYROIDISM
M

Increased PTH secretion Decreased PTH secretion

Hypercalcemia Hypocalcemia

Hypophosphatemia Hyperphosphatemia

Positive chvostek sign

Parathyroidectomy
and trousseau’s sign

Calcitonin Calcium suppliments

RECAPITULATION
 BIBLIOGRAPHY

 Suddarth’s and Brunner. Textbook of medical surgical

nursing, 13th edition; wolters kluwer, 2015, pp- 1487-1490.
 Black M. joyce. Medical surgical nursing. 2nd edition;
malarvizhi S. publisher pp- 1208- 1215.
 Chintamani. Medical surgical nursing, 2nd edition; elsevier,
2015.
THANKYOU