Endocrine - Parathyroid
Part 1
Parathyroid - description
• 4 Parathyroid glands
• Behind thyroid (lobe)
Parathyroid - function
• PTH  h blood Ca
levels
• PTH stimulated by
hypocalcemia
• PTH is inhibited by
hypercalcemia
PTH - function
• h the reabsorption of Ca
& P from bone  blood
• h absorption by sm.
Intestine
• h reabsorption by kidney
• Increases blood Ca levels
• Antagonist to Calcitonin
• It is the most important
regulator of serum Ca
levels.
Calcium
• Why do we need it?
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Bones
Teeth
Blood coagulation
Transmission of nerve
impulses
– Muscle contraction &
relaxation
– Normal heartbeat
Hyperparathyroidism
• Pathophysiology
– h Parathyroid activity

– h PTH 
– (What does PTH
do?????)
– h blood Ca levels 
(out of control)
– Hypercalcemia
Hyperparathyroidism
• Where is the Ca
coming from?
• Movement of Ca out of
the bones  blood
Hyperparathyroidism
• Etiology
– Hyperplasia/ tumor
of parathyroid gland
– Heredity
Hyperparathyroidism
• S&S
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–
–
–
d/t h serum Ca levels
Fatigue/
Depression
Confusion
Polyuria
N/V  anorexia
Kidney stones
• Renal calculi
• S&S
– Cardiac dysrhythmias
– Peptic ulcers
– Pathological fractures
• Back pain
• Bone tenderness
– Coma
– Cardiac arrest
Hyperparathyroidism
• Diagnostic tests
– h serum Ca levels
– X-ray
Hyperparathyroidism
• Medical management
– Goal = i PTH
– h fluids
Hyperparathyroidism
• Pharmaceutical
interventions
– Lasix (Furosemide)
• h renal secretion of
Ca
– Pamidronate (Aredia)
• Calcitonin
• Prevents Ca release
from bones
Hyperparathyroidism
• Surgical management
– If sever  remove
– Remove 3 ½ glands
– Post OP
• Bone pain gone in 3
days
• Renal damage
permanent
HYPOparathyroidism
• Pathophysiology
– i PTH 
– i blood reabsorption
of Ca from bone 
– i serum Ca levels 
– Hypocalcemia
Hypoparathyroidism
• Etiology
– Heredity
– Thyroidectomy
(accidental removal)
–
Hypoparathyroidism
• S&S
– Hypocalcemia causes
neuromuscular
irritability
Hypoparathyroidism
• S&S: Acute
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Tetany
Tingling of fingers
Muscle spasms
Twitching
+ Chvostek’s sign
+ Trousseau’s sign
Hypoparathyroidism
• Chvostek’s sign
– Tap facial nerve 
– Facial spasm
Hypoparathyroidism
• + Trousseau’s sign
– Occlusion of brachial
artery > 3 min.
– Carpal spasm
Hypoparathyroidism
• Chronic S&S
– Lethargy
– Muscle spasms
– Calcification in eyes
or brain
– Convulsions
– Laryngospasms
•  obstruction of
larynx
•  deathmosis
Hypoparathyroidism
• Diagnostic tests
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–
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Chvostek’s sign
Trousseau’s sign
i serum Ca levels
i PTH levels
Hypoparathyroidism
• Medical management
– IV Ca Glugonate
– Breath into bag 
• Acidosis
• In Ca levels
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In Ca diet
Oral Ca
Vitamin D
Thiazide diuretics
Hypoparathyroidism
• Nursing Management
– p For S&S tetany
– p Stridor