PARATHYROIDISM

-an uncommon condition in which the

body produces abnormally low levels of
PTH
CAUSES OF HYPOPARATHYROIDISM
CAUSES OF HYPOPARATHYROIDISM
RISK FACTORS OF HYPOTHYROIDISM
 CLINICAL MANIFESTATIONS
Tingling sensation in lips, toes, and fingers
Muscle Cramps
Muscle Spasms (tetany)
Abdominal Pain
Brain Fog or Confusion Cataracts
arrythmia Weakened tooth enemel
Dry hair and dry scaly skins (children)
Mood changes
Patchy hair loss
Fatigue or Weakness
Brittle nails
 PATHOPHYSIOLOGY
OF
HYPOPARATHYROIDISM
 Hypoparathyroidism Low level of parathyroid hormones

Causes
Hypocalcemia &
hypophosphatemia Severe
*DIGEORGE syndrome - deletion of
22g11 part of the chromosome
Leading to excite neurons more
- immune and cardiac defect Life
- parathyroid gland that can’t Triggers threatening
produce parathyroid hormone complications
Tetany - involuntary
*Removal of parathyroid glands contraction of muscles
during surgery
- Severe
Paresthesia - numbness of seizures
*Autosomal Dominant hands, feet, and around the - cardiac
hypoparathyroidism- mutation in mouth
parathyroid cell calciium - sensing arrythmias
receptor
Changes in cardiac output
*Pseudohypoparathyroidism
type
1. A (Albright heredity osteo
dystrophy) - parathyroid is
not the problem
- bones & kidneys don’t
respond to parathyroid
hormones due to defects in
parathyroid hormone
receptors
*Autoimmune polyendocrine
syndrome type 1
- destruction of parathyroid
gland
Choustek’s sign - facial
muscle in the arm that
leads flexion of the
hand
Trousseau’s Sign -
spasm of muscles in
the arm that leads to
flexion of the hand
Calcification in basal
anglia
Lens of the eye
 DIAGNOSTIC TEST FOR HYPOPARATHYROIDISM

1. Blood test
A. Calcium Testing
B. Parathyroid Testing
C. Vitamin D Testing

2. Imaging Testing
A. Ultrasound
B. CT Scan
C. MRI
 Medical Management
• Pharmacologic therapy.
- Synthetic levothyroxine is the preferred preparation for treating
hypothyroidism and suppressing nontoxic goiters.
• Prevention of cardiac dysfunction.
- As long as metabolism is subnormal and the tissues require
relatively little oxygen, a reduction in the blood supply is tolerated
without overt symptoms of coronary artery disease.
• Supportive therapy.
- Oxygen saturation levels should be monitored; fluids should be
administered cautiously; application of external heat must be
avoided, and oral thyroid hormone therapy should be continued.
 Nursing Interventions
1. Promote rest.
2. Protect against coldness.
3. Avoid external heat exposure.
4. Mind the temperature.
5. Increase fluid intake.
6. Provide foods high in fiber.
7. Manage respiratory symptoms.
8. Pulmonary exercises.
9. Orient to present surroundings.
HYPERPARATHYROIDISM
 Hyperparathyroidism
 Develops from too much activity in one or more parathyroid gland
 caused by overproduction of parathormone by the parathyroid gland
 Characterized by bone decalcification and the development of renal calculi containing
calcium

 PRIMARY HYPERPARATHYROIDISM
 means disorder begins in the parathyroid glands, rather than resulting from another
health problem such as kidney failure
 one or more parahyroid glands is overactive. As a result the gland makes too much parathyroid
hormone (PTH)
 Occurs 2 to 4 times more often in women than in men
 common in people in between 60-70 years of age
 rare in children younger than 15 years old
 half of people diagnosed hyperparathyroidism do not have symptoms
 HYPERPATHYROIDISM
SECONDARY HYPERPARATHYROIDISM

 occurs when parathyroid gland become enlarged and release too much PTH,
causing a high blood level of PTH

Manifestations are similar to those of primary hyperparathyroidism

occurs in patients who have chronic renal failure and so called renal
rickets as a result of phosphorus retention, increased stimulation of
the parathyroid glands, and increased parathormone secretion.
 Causes and Risk Factors

* Mainly occurs in patient over 60 but can be developed in younger adults

 GENDER: Women are most likely to get the condition than men

 RADIATION THERAPY: treatment for other neck cancers can affect the
parathyroid glands

 NUTRITIONAL DEFICIENCIES: Severe, ongoing Vitamins D or calcium

deficiencies can trigger hyperparathyroidism

 LITHIUM USE: Lithium, a drug used to treat bipolar disorder, can affect calcium
levels
 Cont...

 Has a rare, inherited disorder, such as multiple endocrine

neoplasia, type 1, which is usually affects multiple glands
 underlying medical conditions that affects the glands
function
 low calcium levels in the blood
 adenoma
 Cancer of the parathyroid gland (rare)
 Hyperplasia
PATHOPHYSIOLOGY
OF
HYPERTHYROIDISM
 HYPERPARATHYROIDISM

THREE TYPES:
-PRIMARY
-SECONDARY
-TERTIARY

PRECIPITATING
PREDISPOSING FACTORS
FACTORS -Radiation Therapy
-Gender (women) -Nutritional
-Inherited Deficiencies
Disorders -Lithium use (affect
-Other Disorders Ca levels)
PRIMARY HYPERPARATHYROIDISM
CAUSES:
-Adenomas -Hypoplasia Nursing
-Carcinoma -MEN 1 & 2 Considerations:
-Eat a low-calcium,
Growth of the parathyroid gland high-phosphorus
diet
-Increase fluid
Overproduction of PTH intake
-Monitor I & O
Symptoms
Hyperparathyroidace Hypercalcemia Phosphouria
mia

Hypercalciuria Hypophosphatemia

Treatment: Primary
Parathyroidectomy Parathyroidism
Calciumimetics
SECONDARY HYPERPARATHYROIDISM
Causes:
Chronic Kidney Disease
Vitamin D deficiency

Impairs secretion of phosphate Decreased biosynthesis of Vit. D

Stimulate parathyroid gland Nursing

to produce hormone Considerations:
-Eat a low-calcium,
high-phosphorus
Symptoms diet
Hypocalcemia Hyperphosphatemia -Increase fluid
intake
-Monitor I & O
Patient with CKD attempts to
correct these. As CKD progresses,
it becomes more difficult.
Treatment:
-Treatment of CKD
-Use of phosphate Secondary
binders Hyperparathyroidism
TERTIARY HYPERPARATHYROIDISM
CAUSE:
Persistent secondary
hyperparathyroidism

Decreased calcium
Increased phosphate CKD
Nursing
Considerations:
Continue to stimulate -Eat a low-calcium,
parathyroid gland high-phosphorus
diet
-Increase fluid
Hyperplasia intake
-Monitor I & O
PT gland produces
hormone continuously
Treatment: Hypocalcemia Hyperphosphatemia
Parathyroidecto
my Tertiary
Calciumimetics Hyperparathyroidism
 Sign & Symptoms of Hyperparathyroidism
Early hyperparathyroidism
joint pain
muscle weaknessess
fatigue
depression
trouble concentrating
loss of appetite
 Sign & Symptoms of Hyperparathyroidism
Severe hyperparathyroidism
nausea & vomiting
confusion, forgetfulness
increased thirst & need to urinate
constipation
bone pain
 DIAGNOSTIC TEST
 Blood tests
Urine tests
 Bone density test
 X-ray, Ultrasounds, & CT Scan
 Medical Management

Post-Operative Care
Position client to semi-high fowler
Check for excessive bleeding and drain output
Assess for stridor
Medication
Trousseaus and Chvostek’s sign
 Nursing Intervention
 1. monitor vital signs, EKG, renal stone, calcium and phosphate levels
 2. Monitor intake and output
 3. patient should eat low calcium, high phosphorus diet and increase fluid
intake
 4. Provide atleast 3 liters of fluid per day including cranberry and prune
juice
 5. take safety precautions
 6. provide comfort measures
 7. Administer antacids
 GROUP 2

Chegyem, Noel George

Cotteng, Antonette
Cogan, Shenna Ruth
Duquez, Shiela Joy
Ebfan, Eisner
Fogayong, Jether
Fomukao, Kyla
Fumakil, Gizyla Mae
Gungangac, An
Galula, Daryl Ivee
Hidalgo, Divine Grace
Inodayan, Joan