Parathyroid glands anatomy, physiology, Hyperparathyroidism ,hypopararhyroidism Signs and symptoms, medical management and nursing management

1. Parathyroid disorders

2. Title page : advance concept of Nursing
presentation
Presentation of Advanced concept of
nursing
Submitted to : Sir hira laal
Submitted By:
Fazila khan,faryal,farkhanda
Class : Post RN BSc Nursing
Semester : 1
Batch 2021-2023
College of Nursing jpmc
Date of submission:27 July 2022

3. Acknowledgement
• It gives me great pleasure to express my gratitude toward our
ACN teacher sir Hira laal for his guidance, support and
encouragement through out this presentation.
• I would like to thanx my family members without their
motivation and help the successful completion of this
presentation wouldn’t have been possible .
• I would like to thanx my Allah pak who made me able to stand
at front of you.

4. Objectives of the presentation
• At the end student will be able to
• Understand parathyroid gland anatomy and physiology
• Understand hyperparathyroidism and hypoparathyroidism
• Understand signs and symptoms, types,complications and
management including nursing management of
parathyroid disorders
• Understand osteoporosis related symptoms and
management
• Understand tetany and its specific symptoms
• Understand diet regarding disorders

5. Definition of parathyroid disorders
• Parathyroid disorders lead
to abnormal levels of calcium in
the blood that can cause brittle
bones, kidney stones, fatigue,
weakness, and other problems.

7. Anatomy of parathyroid gland

8. Back view of parathyroid gland

9. Functions of parathyroid glands

14. Signs and symptoms of hyperparathyroidism
Symptoms may be so mild and nonspecific that they don't seem related to
parathyroid function, or they may be severe. The range of signs and symptoms
include:
• Weak bones that break easily (osteoporosis)
• Kidney stones
• Excessive urination
• constipation
• Bone and joint pain
• Frequent complaints of illness with no clear cause
• Nausea, vomiting
• Short Q T interval
• Serum cal 10.5 more

16. Types of hyperparathyroidism

17. Primary hyperparathyroidism
• Primary hyperparathyroidism
• Primary hyperparathyroidism occurs because of a problem with one
or more of the four parathyroid glands:
• A noncancerous growth (adenoma) on a gland is the most
common cause.
• Enlargement (hyperplasia) of two or more parathyroid glands
accounts for most other cases.
• A cancerous tumor is a very rare cause of primary
hyperparathyroidism.

18. Tumour or hyperplasia

19. Secondary hyperparathyroidism
• Severe calcium deficiency. Your body may not get enough calcium from
your diet, often because your digestive system doesn't absorb the calcium from
food. This is common after intestinal surgery, including weight loss surgery.
• Severe vitamin D deficiency. Vitamin D helps maintain appropriate
calcium levels in the blood. It also helps your digestive system absorb calcium
from your food.
• Your body produces vitamin D when your skin is exposed to sunlight. You also get
some vitamin D in food. If you don't get enough vitamin D, then calcium levels
may drop.
• Chronic kidney failure. Your kidneys convert vitamin D into a form that your
body can use. If your kidneys work poorly, usable vitamin D may decrease and
calcium levels drop. This causes parathyroid hormone levels to go up. Chronic
kidney failure is the most common cause of secondary hyperparathyroidism.

20. Secondary parathyroidism due to CRF

21. Risk factors
• Risk factors
• You may be at an increased risk of primary hyperparathyroidism if
you:
1. Are a woman who has gone through menopause
2. Have had prolonged, severe calcium or vitamin D deficiency
3. Have a rare, inherited disorder, such as multiple endocrine
neoplasia, type 1, which usually affects multiple glands
4. Have had radiation treatment for cancer that has exposed your
neck to radiation
5. Have taken lithium, a drug most often used to treat bipolar disorder

22. Complications
• Osteoporosis. The loss of calcium from bones often results in weak,
brittle bones that break easily (osteoporosis).
• Kidney stones. Too much calcium in your blood may lead to too
much calcium in your urine. This can cause small, hard deposits of
calcium and other substances to form in your kidneys (kidney stone). A
kidney stone usually causes major pain as it passes from the kidneys
through the urinary tract.
• Cardiovascular disease. Although the exact cause-and-effect
link is unclear, high calcium levels are associated with heart and blood
vessel (cardiovascular) conditions, such as high blood pressure and
certain types of heart disease.

23. Osteoporosis
• When one of the parathyroid glands is
overactive (hyperparathyroidism) the
parathyroid tumor makes too much PTH
hormone which then causes our bones to
release calcium constantly into the blood
stream. This causes the bones to lose their
density and hardness (it is the calcium that
makes them hard). Loss of calcium from bones
is called osteoporosis.

24. Osteoporotic bones vs normal bones

25. Diagnostic labs
Blood tests
1.Serum calcium
2.Serum phosphorus level
3.Vitamin d 3 levels
4.Parathyroid hormone levels
*Bone mass density test
* Ultrasounds of kidneys for stones
*EKG for arrhythmia prolonged QR interval

26. Medical treatment: Surgery
• Surgery
• Surgery to remove the overactive parathyroid gland or glands is the only
sure way to cure primary hyperparathyroidism. Doctors recommend surgery
for people with clear symptoms or complications of the disease

27. Surgical interventions
• Surgeonsusetwo main types of operations to removethe overactive gland or glands.
• Minimallyinvasive parathyroidectomy. Also called focused parathyroidectomy,
surgeonsusethis typeofsurgerywhen they think only one of theparathyroid glands is
overactive.
• Bilateral neck exploration.Thistype of surgeryusesa largerincision that lets the
surgeonfind and look at all fourparathyroid glands and removetheoveractiveones.

28. Nursing mangement after
parathyroidectomy
• Monitor vital signs temperature, pulse, respiratory rate.
• Monitor EKG for Q and T interval because Q R interval short in
hyperparathyroidism.
• Monitor urine out put .
• Monitor calcium and phosphorus levels.
• Keep semi fowler position.
• Assess for bleeding ,edema,drainage at wound site.
• Encourage fluid intake as tolerated .

29. For Restoration of bone
• Diet fortified with calcium
• Calcium Medications
• Anabolic steroids
• Vitamin d3
• Calcitonin
• Physiotherapy exercises
• massage

31. Pathophysiology

32. Causes of hypoparathyroidism
• Thyroid surgery
• Parathyroid gland surgery
• Autoimmune disorders
• Idiopathic

37. Clinical features

38. Diagnostic tests

39. Complications
1. Calcification of basal ganglia
2. Calcification of lens of the eye
3. Cardiac dysarrythmias
4. Diarrhea
5. Tetany

42. Medical management of
hypoparathyroidism
Oral calcium. Oral calcium supplements — as tablets, chews or liquid — can
increase calcium levels in your blood. However, at high doses, calcium
supplements can cause digestive side effects, such as constipation, in some
people.
Vitamin D. High doses of vitamin D, generally in the form of calcitriol, can help your
body absorb calcium and eliminate phosphorus. Calcitriol is a prescription from your
health care provider for active vitamin D. This is different from the usual
supplements you can get without a prescription.
Magnesium. If your magnesium level is low and you're experiencing symptoms of
hypoparathyroidism, you may need to take a magnesium supplement.
Thiazide diuretics. If your calcium levels remain low even with treatment, or if the
amount of calcium in your urine is very high, thiazide diuretics can help decrease
the amount of calcium lost through your urine.
Parathyroid hormone replacement. The U.S. Food and Drug Administration (FDA)
has approved parathyroid hormone (Natpara) for low blood calcium due to
hypoparathyroidism. This is a once-daily injection. Because of the potential risk of
bone cancer (osteosarcoma), a risk observed in animal studies, this drug is
available only through a restricted program. The program limits use to people
whose calcium levels can't be controlled with calcium and vitamin D supplements
and who understand the risks.

43. Diet regarding treatment
• Diet
• Your health care provider might recommend that you consult a
registered dietitian, who is likely to advise a diet that's:
• Rich in calcium. This includes dairy products, green leafy
vegetables, broccoli and foods with added calcium, such as some
orange juices and breakfast cereals.
• Low in phosphorus. This means avoiding carbonated soft drinks,
which contain phosphorus in the form of phosphoric acid, and
limiting processed foods, meats, hard cheeses, nuts and whole
grains.

45. Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175670/
https://www.mayoclinic.org/diseases-
conditions/hypoparathyroidism/diagnosis-treatment/drc-20355381