Lecture Notes: Hypoparathyroidism vs. Hyperparathyroidism

Overview

• Hypoparathyroidism: Low secretion of parathyroid hormone (PTH) by the parathyroid gland, resulting in hypocalcemia (low calcium) and hyperphosphatemia (high phosphate).
• Hyperparathyroidism: High secretion of PTH by the parathyroid gland, leading to hypercalcemia (high calcium) and hypophosphatemia (low phosphate).

Causes

Hypoparathyroidism

• Damage or Manipulation: Often due to thyroidectomy or surgery affecting the parathyroid glands.
• Low Magnesium Levels (Hypomagnesemia): Magnesium is crucial for parathyroid function.
• Autoimmune Disorders: Body produces antibodies that attack the gland.
• Resistance to PTH: Kidneys and bones do not respond effectively to PTH.

Hyperparathyroidism

• Primary Cause: Issue with the gland itself, such as hyperplasia, adenoma, or cancer.
• Secondary Cause: Conditions like chronic renal failure or vitamin D deficiency affecting parathyroid function.

Signs and Symptoms

Hypoparathyroidism

• Mnemonic "PTH":
  • Paresthesia: Tingling/numbness in lips, fingers, toes.
  • Trousseau’s and Chvostek’s Signs: Indicate neuromuscular irritability.
  • Tetany: Muscle cramps leading to potential bronchospasms.
• Labs: Hypocalcemia, hyperphosphatemia.

Hyperparathyroidism

• Bone Fractures: Due to bone resorption and calcium release.
• Constipation: Result of decreased muscle contractions.
• Renal Calculi: Kidney stones from excess calcium.
• Nausea/Vomiting: High calcium increases gastric acid.
• Excessive Urination: Kidneys overworking to excrete calcium.

Nursing Interventions

Hypoparathyroidism

• Monitor: Vital signs, especially respiratory status due to tetany.
• Administer Medications:
  • IV Calcium: e.g., Calcium gluconate (watch for digitalis toxicity).
  • Oral Calcium with Vitamin D: Enhances calcium absorption.
  • Phosphate Binders: e.g., Aluminum carbonate to reduce phosphate.
  • Parathyroid Hormone Replacement: e.g., Natpara (monitor calcium levels).

Hyperparathyroidism

• Monitor: Vital signs, urine for kidney stones.
• Encourage Fluid Intake: Monitor patients with CHF/renal failure.
• Surgical Treatment: Parathyroidectomy for primary causes.
• Administer Medications:
  • IV Hydration: E.g., Normal saline for hydration.
  • Calcimimetics: E.g., Cinacalcet for secondary hyperparathyroidism.
  • Calcitonin: Lowers calcium levels and protects bones.
  • Loop Diuretics: E.g., Lasix to reduce calcium levels (watch potassium).
  • Bisphosphonates: E.g., Fosamax to strengthen bones (administer with precautions to prevent GI issues).

Conclusion

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