Hyperparathyroidism and Hypoparathyroidsm

Question 1

what is hyperparathyroidism?

Answer 1

increase in parathyroid hormone (PTH) secretion, which
regulates calcium and phosphate levels by stimulating bone resorption, renal reabsorption of
calcium, and activation of vitamin D. Excessive PTH secretion causes hypercalcemia (high
calcium levels).

Question 2

what are the different types of hyperparathyroidsm?

Answer 2

1. Primary Hyperparathyroidism:
   ○ Caused by increased PTH secretion.
   ○ Leads to problems with calcium, phosphate, and bone metabolism.
   ○ Most common cause: benign tumor (adenoma) in the parathyroid gland.
   ○ Risk factors: head/neck radiation and long-term lithium therapy.
   ○ Common in people aged 40–50, more frequent in women.
2. Secondary Hyperparathyroidism:
   ○ Compensatory response to hypocalcemia (low calcium levels), the main
   stimulus for PTH secretion.
   ○ Causes: Vitamin D deficiency, malabsorption, chronic kidney disease, and
   hyperphosphatemia.
3. Tertiary Hyperparathyroidism:
   ○ Parathyroid hyperplasia with a loss of negative feedback from calcium levels.
   ○ Seen in patients after kidney transplant following long dialysis treatments.

Question 3

Your patient has been living with hyperparathyroidism. You see their labs and imaging. What can be some findings you see from this information?

Answer 3

● High PTH levels lead to hypercalcemia and hypophosphatemia (low phosphate
levels).
● Bone density decreases due to increased bone resorption.
● Hypercalciuria (high urinary calcium) can lead to kidney stones

Question 4

Your paitent comes in and suspects they have hyperparathyroidism. What clinical manifestations may they present?

Answer 4

● Symptoms range from asymptomatic to overt signs due to hypercalcemia:
○ Loss of appetite, constipation, fatigue, emotional disturbances.
○ Muscle weakness, especially in the lower extremities.
○ Shortened attention span.

Question 5

what are the complications of hyperparathyroidism?

Answer 5

● Osteoporosis, renal failure, kidney stones.
● Pancreatitis, cardiac changes, and fractures of long bones, ribs, and vertebrae

Question 6

what are the diagnostic studies of hyperparathyroidism?

Answer 6

● Increased PTH levels.
● Serum calcium levels exceed 10 mg/dL.
● Serum phosphorus levels less than 3 mg/dL due to inverse relationship with calcium.
● Asymptomatic hypercalcemia detected through routine chemistry panels.
● Other elevated values: urine calcium, serum chloride, uric acid, creatinine, amylase
(if pancreatitis present), and alkaline phosphatase (if bone disease present).
● Bone density tests (e.g., DEXA) detect bone loss.
● MRI, CT, and ultrasound may detect adenomas.

Question 7

what is the goal of care for hyperparathyroidism? what does treatment depend on?

Answer 7

The goal is to relieve symptoms and prevent complications caused by excess PTH.
Treatment depends on the urgency, degree of hypercalcemia, and underlying cause.

Question 8

what are the surgery options for a patient with hyperparathyroidism?

Answer 8

Surgical Therapy:
● Parathyroidectomy (partial or complete removal) is the most effective treatment for
primary and secondary hyperparathyroidism.
○ Performed via endoscopy on an outpatient basis
○ Criteria: Serum calcium levels more than 1 mg/dL above the upper normal limit,
hypercalciuria (greater than 400 mg/day), bone mineral density reduction, overt
symptoms, or age under 50.
○ Results in rapid calcium reduction.
● Autotransplantation of normal parathyroid tissue (e.g., in forearm or near the
sternocleidomastoid muscle) is performed if multiple glands are removed. This allows
PTH secretion to continue normally. If autotransplantation fails, lifelong calcium
supplementation is required.

Question 9

Your patient suffers from hyperparathyroidism. They are not getting surgery, so what would they need to do to control their condition long term?

Answer 9

Nonsurgical Therapy:
● Used in patients who are asymptomatic or have mild symptoms.
● Ongoing monitoring of serum PTH, calcium, phosphorus, alkaline phosphatase,
creatinine, BUN, and urinary calcium.
● Annual x-rays and DEXA scans for bone loss.
● Encourage continued ambulation and avoid immobility.
● Dietary measures: High fluid intake and moderate calcium intake.

Question 10

Your patient has been diagnoised with severe hypercalcemia. What order is expected to be placed by their HCP?

Answer 10

● IV sodium chloride and loop diuretics (e.g., furosemide) to increase urinary calcium
excretion.

Question 11

what medications are used to treat hyperparathyroidism?

Answer 11

Medications:
● Bisphosphonates (e.g., alendronate): Inhibit osteoclastic bone resorption, normalize
calcium levels, and improve bone density.
● IV bisphosphonates (e.g., pamidronate): Quickly lower serum calcium in cases of
dangerously high levels.
● Phosphates: Given to patients with normal renal function and low serum phosphate.
● Calcimimetic agents (e.g., cinacalcet): Increase the sensitivity of calcium receptors on
the parathyroid gland, lowering PTH secretion and calcium levels.
○ Useful for secondary hyperparathyroidism in patients with chronic kidney
disease on dialysis or parathyroid cancer.

Question 12

what does post-parathyroidectomy care consist of? what are the major complications?

Answer 12

● Nursing care is similar to that after a thyroidectomy.
● Major complications include:
○ Bleeding
○ Fluid and electrolyte imbalances

Question 13

what is tetany ?

Answer 13

Tetany:
● Tetany is a condition of neuromuscular hyperexcitability due to a sudden drop in
calcium levels.
● It may occur early postoperatively or develop several days later.
Signs of Tetany:
1. Mild Tetany:
○ Tingling of hands and around the mouth.
○ Symptoms should decrease over time.
2. Severe Tetany:
○ Muscle spasms, including laryngospasms.
○ Treatment: Administer IV calcium.
○ IV calcium gluconate should be readily available in case of acute tetany

Question 14

Your’e assigned a patient with hyperparathyroidism. what type of assessments are you going to preform while taking care of them?

Answer 14

● Monitor fluid status by tracking intake and output.
● Assess serum levels of:
○ Calcium
○ Potassium
○ Phosphate
○ Magnesium
● Chvostek’s and Trousseau’s signs should be monitored to assess for neuromuscular
irritability (indicative of hypocalcemia).

Question 15

you are discharging a patient who opted out of surgery for their hyperparathyroidism. What are you going to include in their discharge instructions?

Answer 15

Non-Surgical Management:
If surgery is not performed:
● Symptom relief and complication prevention become the primary focus.
Meal Plan:
● Help the patient adapt their meal plan to suit their lifestyle.
● A dietitian referral may be helpful for individualized meal planning.
Exercise:
● Stress the importance of an exercise program to prevent bone loss (immobility
worsens bone loss).
● Mobility helps promote bone calcification.

Question 16

what type of education should be given to a patient with hyperparathyroidism?

Answer 16

● Teach the patient to recognize and report signs of:
○ Hypocalcemia
○ Hypercalcemia
● Encourage patients to keep regular follow-up appointments.

Question 17

what is the definition and patho of hypoparathyroidism?

Answer 17

● Hypoparathyroidism is an uncommon condition where there is inadequate circulating
PTH (parathyroid hormone).
● Hypocalcemia occurs due to the lack of PTH, which maintains serum calcium levels.
● Pseudohypoparathyroidism: PTH resistance at the cellular level, caused by a genetic
defect, results in hypocalcemia despite normal or high PTH levels.
○ Often associated with hypothyroidism and hypogonadism.

Question 18

what is the etiology/cause of hypoparathyroidism?

Answer 18

1. Iatrogenic (most common cause):
   ○ Accidental removal of parathyroid glands or damage to their vascular supply
   during neck surgery (e.g., thyroidectomy).
2. Idiopathic Hypoparathyroidism:
   ○ Rare, due to the absence, fatty replacement, or atrophy of the glands.
   ○ May occur early in life and can be associated with other endocrine disorders
   (antiparathyroid antibodies may be present).
3. Other Causes:
   ○ Severe hypomagnesemia (due to malnutrition, alcohol use, or renal failure)
   suppresses PTH secretion.
   ○ Tumors and heavy metal poisoning can also cause hypoparathyroidism.

Question 19

Joe comes in for his physical. After the assessment, his HCP suspects hypoarathyroidism. what are the clinical manifestations does Joe present?

Answer 19

● Symptoms of acute hypoparathyroidism are due to hypocalcemia:
○ Tetany: Tingling of the lips and stiffness in the extremities.
○ Tonic muscle spasms (smooth and skeletal), causing dysphagia and
laryngospasms (can compromise breathing).
○ Lethargy, anxiety, and personality changes.

Question 20

You take a look at Joes labs, what labs suggest he has hypoparathyroidism?

Answer 20

● Decreased serum calcium and PTH levels.
● Increased phosphate levels.

Question 21

Joe has hypoparathyroidism. What goals can we establish for him?

Answer 21

1. Manage acute complications like tetany.
2. Maintain normal serum calcium levels.
3. Prevent long-term complications.

Question 22

Joe is experiencing tetany. what is the emergency treatment? how would we administer it? what do we need to know about this drug?

Answer 22

Emergency Management of Tetany:
● IV Calcium administration is required in emergencies.
Administration Tips:
● Give IV calcium slowly.
● Use ECG monitoring to observe for:
○ Hypotension
○ Dysrhythmias
○ Cardiac arrest
● Patients on digoxin are more vulnerable to complications from calcium administration.
● Calcium chloride can cause venous irritation and inflammation. Extravasation may
lead to cellulitis, necrosis, and tissue sloughing.

Question 23

Joe’s nurse teaches him the rebreathing technique during his tetany episode. What is the nurse’s rationale and how does she teach it?

Answer 23

● Helps relieve acute neuromuscular symptoms (muscle cramps, mild tetany).
● Procedure: Instruct the patient to breathe in and out of a paper bag or breathing mask.
○ This reduces CO2 excretion, increases carbonic acid levels in the blood, and
lowers pH (creating an acidic environment that enhances calcium ionization)

Question 24

Joe is asking what type of supplements will he need to take for long term management of hypoparathyroidism. What would his nurse suggest?

Answer 24

● Patients are prescribed oral calcium supplements, magnesium supplements, and
vitamin D.
● PTH replacement is not commonly recommended due to cost and the need for
parenteral administration.
● Vitamin D (e.g., calcitriol) enhances intestinal calcium absorption and increases
calcium levels rapidly.

Question 25

Aside from supplements, Joe is asking what foods should he eat and what foods should he avoid. Wha is the nurses response?

Answer 25

● High-calcium foods:
○ Dark green vegetables (e.g., kale, broccoli)
○ Soybeans, tofu
● Foods to Avoid:
○ Foods containing oxalic acid (e.g., spinach, rhubarb), as they inhibit calcium
absorption.

Question 26

what do we need to teach to a patient with hypoparathyroidism?

Answer 26

● Teach the patient about follow-up care and the need for regular monitoring of calcium
levels (3-4 times per year).