Med-Surg Endocrine System part 17: Hypoparathyroidism and Hyperparathryoidism

by Cathy Parkes September 21, 2020

In this video

Review

  • Parathyroid glands review
  • Parathyroid hormone (PTH) & the three ways it increases calcium

Hypoparathyroidism

  • Pathophysiology of hypoparathyroidism
  • Main cause of hypoparathyroidism
  • Signs and symptoms of hypoparathyroidism
  • Lab values associated with hypoparathyroidism
    • PTH
    • Calcium
    • Phosphorus
    • Treatment (medications)
  • Nursing care for hypoparathyroidism
    • Seizure precautions
    • Diet for hypoparathyroidism

Hyperparathyroidism

  • Pathophysiology of hyperparathyroidism
  • Primary cause of hyperparathyroidism
  • Secondary cause of hyperparathyroidism
  • Lab values associated with hypoparathyroidism
    • PTH
    • Calcium
    • Phosphorus
    • Relationship between calcium and phosphorus
  • Signs and symptoms of hyperparathyroidism
    • Hyperparathyroidism’s relationship to hypercalcemia
  • Treatment of hyperparathyroidism
    • Medications for hyperparathyroidism
    • Parathyroidectomy surgery
  • Nursing care for hyperparathyroidism
    • Fall precautions
    • Diet for hyperparathyroidism

Full transcript

In this video, we are going to talk about hypoparathyroidism and hyperparathyroidism. If you are following along with cards, I'm on card 41.

Before we get into those two disorders, let's do a quick review of the parathyroid glands. So there are four of them, and they are right next to the thyroid gland. It actually looks like the thyroid gland has been bedazzled with parathyroid glands, if you take a look at a picture.

These parathyroid glands release PTH. PTH causes increased calcium levels in the bloodstream, and it does this three ways. One is it pulls calcium out of the bones into the bloodstream. It also causes increased reabsorption of calcium at the kidneys, and it causes increased absorption of calcium in the intestines, and that's how it brings those calcium levels up in the bloodstream.

With hypoparathyroidism, we have decreased or insufficient secretion of PTH, and this causes those calcium levels to go down, because those parathyroid glands are not working correctly.

And the main cause of this issue is that during a thyroidectomy, which is removal of the thyroid gland, we have nicked and damaged those parathyroid glands, and when we damage them, they don't produce their PTH, and causes those calcium levels to come down.

In terms of signs and symptoms of this disorder, if we have hypoparathyroidism, we're basically going to see the same signs and symptoms we would see for someone who has hypocalcemia, so low levels of calcium. So this includes muscle cramps, numbness and tingling, a positive Chvostek's sign, as well as a positive Trousseau's sign. We may also see tetany or seizures and possibly dysrhythmias as well.

In terms of labs, when we have hypoparathyroidism we will have decreased PTH. So decreased parathyroid hormone.

In addition, we will have hypocalcemia, so levels of calcium will be under 9.

And then we will have hyperphosphatemia. So you may recall, when we have high levels of calcium, we'll have low levels of phosphorous, and the opposite is true too. If we have high levels of phosphorous, we have low levels of calcium. They have this inverse relationship. So with this disorder, we'll have hypocalcemia, but hyperphosphatemia.

In terms of treatment, we would provide a patient with this disorder with calcium gluconate, so we want to try to get those calcium levels up. We would give them calcium as well as Vitamin D supplements because Vitamin D is essential to allow for the absorption of calcium. And then we can also give them phosphate binders to help bring those phosphorous levels down.

In terms of nursing care, we're going to want to implement seizure precautions because of the risk of seizures. So we're going to pad those side-rails of the bed and make sure we have oxygen equipment available at the bedside, etc.

We're going to provide the patient with a high-calcium, low-phosphorous diet.

And then also give the patient phosphate binders with their meals.

Now let's talk about hyperparathyroidism. This is where we have hypersecretion, excess secretion, of PTH from the parathyroid glands.

And this may be due to primary or secondary causes. The primary cause would be an adenoma which is a benign tumor on the parathyroid gland that causes excess secretion of PTH.

One of the secondary causes of hyperparathyroidism would be kidney disease. So with kidney failure or kidney disease, we have hypocalcemia. So our calcium levels are very low. And the parathyroid glands, they sense that and they're trying to compensate. So they pump out all this extra PTH to bring up those calcium levels. And in the process, when we have all that PTH, that pulls calcium out of the bones, into the bloodstream. And those levels just keep coming up.

In terms of labs, we would see high levels of PTH, high levels of calcium, and low levels of phosphorus.

For signs and symptoms, the signs and symptoms of hyperparathyroidism are going to be consistent with the signs and symptoms of hypercalcemia. So this includes fatigue, muscle weakness. We also may see bone pain and deformities, because we're pulling all that calcium out of the bones. Nausea and vomiting, weight loss, constipation, hypertension as well as kidney stones and dysrhythmias are also possible side effects.

In terms of treatment, medications we can use include furosemide, which is Lasix. That helps to increase excretion of calcium, and bring those blood levels down. We can also give a patient calcitonin. So if you recall, calcitonin helps to tone down calcium levels in the bloodstream. And then we can also give the patient phosphates to help bring those phosphorus levels up.

Surgery may also be needed if the patient has an adenoma. If they have the primary cause of hyperparathyroidism. So they may need a parathryoidectomy, so removal of the parathyroid gland.

And then in terms of nursing care, we're going to want to implement safety precautions for this patient, because the excess levels of PTH is causing calcium to be pulled out of the bones, those bones are going to be really weak and fragile. And so if that patient were to fall, then it could be really tragic. So we're definitely going to want to provide for patient safety, assist the patient with ambulation, make sure they do not fall.

We also want to provide the patient with a low-calcium, high-phosphorus diet, and increase their fluid intake as well, to help prevent that constipation as well as the risk for kidney stones.

Hopefully this video has been helpful. In my next video, we will talk about diabetes in depth. Thank you so much for watching and take care!


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