Parathyroid Study Questions

Question 1

Where are the parathyroid glands?

Answer 1

4 small paired glands located in the back of each thyroid lobe

Question 2

What does the parathyroid secrete?

Answer 2

Parathyroid hormone (PTH)

Question 3

What does PTH do?

Answer 3

Regulates calcium
Stimulates bone resorption & inhibition of bone formation -> Ca+ & PO4 release into blood
In kidneys: Increases Ca+ reabsorption & PO4 excretion
Stimulates renal conservation of Vit. D (enhances absorption)

Question 4

What happens when serum Ca+ levels are low?

Answer 4

PTH secretion increases

Question 5

What happens when serum Ca+ levels are high?

Answer 5

PTH secretion is inhibited

Question 6

What other high level can inhibit PTH?

Answer 6

Vitamin D

Question 7

What other low level can stimulate PTH?

Answer 7

Magnesium

Question 8

If calcium levels rise above the set point, what does the thyroid gland secrete to inhibit PTH?

Answer 8

Calcitonin

Question 9

What is hyperparathyroidism?

Answer 9

Increased levels of PTH

Question 10

What is the most common cause of hyperparathyroidism?

Answer 10

Benign adenoma

Question 11

What are the main s/s of hyperparathyroidism?

Answer 11

Osteoporosis
Constipation
Risk for renal calculi

Question 12

How are the symptoms tx?

Answer 12

No tx for hyper; symptomatic tx only

Question 13

What type of hyperparathyroidism is due to hyperplasia of the glands?

Answer 13

Primary

Question 14

What type of hyperparathyroidism is due to disorders causing hypocalcemia?

Answer 14

Secondary (vit D deficiency, malabsorption, CRF, hyperphosphatemia)

Question 15

What type of hyperparathyroidism is due to an increased release of PTH even though Ca+ levels are normal?

Answer 15

Tertiary (often seen after kidney transplant following long standing dialysis tx for CRF)

Question 16

What can chronic hypercalcemia in hyperparathyroidism cause?

Answer 16

Bones (skeletal changes / osteoporosis / fx)
Stones (renal damage/ kidney stones)
Groans (Abd/GI malfunction)
Moans (psychiatric developments)
Neuromuscular changes

Question 17

Remember the tx for risk of renal calculi?

Answer 17

Strain urine; force fluids (cranberry juice)

Question 18

What is the goal of hyperparathyroid tx?

Answer 18

Relieve symptoms; prevent complications

Question 19

Since hyperparathyroidism is linked to hypercalcemia, what should tx include?

Answer 19

Drink 4-5 liters water daily
Limit Ca+ & Vit D
Give Phosphorus supplements (except w/ CRF)

Question 20

What needs to be increased in the diet?

Answer 20

Na+ (8-10 grams/day)

Question 21

What tx measures should be taken for hyperparathyroidism?

Answer 21

IV saline
Lasix (NOT thiazides)
Steroids (decrease GI absorption of Ca+)
Anti-resorption agents (inhibit bone resorption/loss)
Calcitonin

Question 22

What are the two types of Calcitonin?

Answer 22

Salmon (2x stronger)

Human (used when sensitive to non-human)

Question 23

What are other anti-resorption agents?

Answer 23

Mithramycin
Etidronate disodium (Didronel)
Pamidronate sodium (Aredia)

Question 24

What are calcimimetic agents [Cinacalcet (Sensipar)] used for?

Answer 24

To ↑ sensitivity to Ca+ receptor on parathyroid gland

Increases PTH secretion & Ca+ serum levels (spares Ca+ stores in bone)

Question 25

What other disorders are this drug used for?

Answer 25

Pagets disease Postmenopausal osteoporosis Hypercalcemia

Question 26

Who should NOT take Salmon Calcitonin?

Answer 26

Allergic to salmon & fish

Question 27

How can therapeutic effects of salmon calcitonin be alleviated?

Answer 27

Ensure adequate diet & do small frequent feedings | Alternate nostrils daily if intranasal form

Question 28

What levels should be checked prior to starting & then ongoing?

Answer 28

Calcium & Vit D levels | NOTE: Calcitonin’s are sub-Q & IM drugs – Teach pt how to do injections

Question 29

What may be done to prevent injury r/t osteoporosis with the hyperparathyroid pt?

Answer 29

Keep bed low Assist w/ activity Implement exercise program to prevent bone loss

Question 30

What kind of diet should the hyperparathyroid pt be on?

Answer 30

Low Ca+ diet; avoid milk/dairy products

Question 31

What may be done to prevent constipation?

Answer 31

Fluids, increased activity, fiber, stool softeners

Question 32

What may be given to decrease the risk of peptic ulcers?

Answer 32

Antacids or H2 receptor antagonists

Question 33

What disorder may be seen when T3 levels are increased?

Answer 33

Pancreatitis

Question 34

What is the most effective tx of primary & secondary hyperparathyroidism?

Answer 34

Parathyroidectomy

Question 35

What is the criteria for a parathyroidectomy?

Answer 35

Calcium level > 12mg/dL Hypercalciuria (> 400 mg/day) Marked reduced bone density Overt symptoms (i.e. renal calculi, neuro changes)

Question 36

What is usually done when a parathyroidectomy is performed to allow for continued PTH secretion?

Answer 36

Autotransplantation of normal parathyroid tissue in Forearm or near sternocleidomastoid muscle)

Question 37

If autotransplantation isn’t possible or fails, what must be done?

Answer 37

Lifelong calcium supplements

Question 38

What is the greatest risk after a parathyroidectomy?

Answer 38

Same as thyroidectomy – HYPOcalcemia

Question 39

What needs to be at bedside in case tetany occurs?

Answer 39

IV Calcium gluconate

Question 40

What signs should you be monitoring post-parathyroidectomy?

Answer 40

Chvosteks, Trousseaus

Question 41

What drug should be administered with caution?

Answer 41

Digitalis (Lanoxin)

Question 42

What causes “hungry bone syndrome”?

Answer 42

Rapid bone rebuilding post-parathyroidectomy

Question 43

What is hypoparathyroidism?

Answer 43

Decreased PTH secretion | Failure to respond despite normal to high PTH levels (pseudohypoparathyroidism)

Question 44

What are iatrogenic causes of hypoparathyroidism?

Answer 44

Accidental removal, infarction, strangulation

Question 45

What are idiopathic causes of hypoparathyroidism?

Answer 45

Autoimmune

Question 46

What other abnormal electrolyte can cause hypoparathyroidism?

Answer 46

Hypomagnesemia (alcoholic, prolonged TPN use, malabsorption disorders)

Question 47

What occurs with lowered levels of PTH?

Answer 47

Serum Ca+ levels fall PO4 levels increase May have calcification of eyes (irreversible)

Question 48

What manifestations may be seen with hypoparathyroidism? (Focused assessment)

Answer 48

Hypocalcemic s/s – Tetany,seizures, laryngeal spasm, neuromuscular excitability

Question 49

How is hypoparathyroidism diagnosed?

Answer 49

Low serum Ca+ Low serum PTH High serum PO4

Question 50

What may be used for maintenance therapy in the pt with hypoparathyroid?

Answer 50

Calcium Supplements

Question 51

When should calcium supplements be given?

Answer 51

30 minutes to 1 hour after meals with a FULL glass of water

Question 52

What may need to be administered to decrease PO4 & increase Ca+?

Answer 52

PO4 binders (Amphogel/Basogel)

Question 53

What is the tx for acute hypocalcemia?

Answer 53

Tx tetany w/ IV calcium gluconate | Monitor for hypotension & cardiac arrest

Question 54

What drugs are given for long-term mgt of hypoparathyroidism?

Answer 54

``` Antihypocalcemics: Vitamin D analogues Calcitriol Oral Ca+ supplements Calcium carbonate Oyster shell Ca+ PTH replacement ```

Question 55

What do vitamin D analogues do?

Answer 55

Promote Ca+ absorption from GI/renal tubules | Promote secretion of Ca+ from bone

Question 56

What education should pt be given about Calcitriol?

Answer 56

``` Swallow tablets whole High Ca+/Low PO4 diet Normal sunlight exposure Avoid Vit D! Avoid Mg containing antacids Have Ca+ level assessed weekly at first S/S dehydration ```