The document discusses disorders of the parathyroid gland, including hyperparathyroidism and hypoparathyroidism. It describes the anatomy and location of the parathyroid glands, their blood supply, and innervation. It then examines the causes, symptoms, diagnostic tests and treatments for hyperparathyroidism and hypoparathyroidism. Surgical removal of overactive parathyroid glands is often used to treat hyperparathyroidism, while lifelong calcium and vitamin D supplements are generally required to manage hypoparathyroidism.

1. DISORDERS OF
PARATHYROID GLAND
Justin V Sebastian

2. ▪ The parathyroid glands are small endocrine glands located in the anterior
neck. They are responsible for the production of parathyroid hormone,
which acts to control calcium levels in the body.
▪ This article will consider the anatomical location, vessels and nerves of
the parathyroid glands, as well as some clinical correlations.

3. ▪The parathyroid glands are located on the posterior aspect of the lateral lobes of the
thyroid gland. They are flattened and oval in shape, situated external to the gland
itself, but within its sheath.
▪The majority of people have four parathyroid glands, although variation in
number is common. Anatomically, the glands can be divided into two pairs:
▪Superior parathyroid glands – Derived embryologically from the fourth
pharyngeal pouch. They are located approximately 1cm superior to the entry
of the inferior thyroid arteries into the thyroid gland (at level of the inferior
border of the cricoid cartilage).

4. ▪Inferior parathyroid glands – Derived embryologically from the third
pharyngeal pouch. Although inconsistent in location between individuals,
the inferior parathyroid glands are usually found near the inferior poles of
the thyroid gland. In a small percentage of people, the glands can be found
as far inferiorly as the superior mediastinum.
▪Vascular Supply
▪The posterior aspect of the thyroid gland is supplied by the inferior thyroid
arteries. Thus, its branches also supply the nearby parathyroid glands.
Collateral circulation is delivered by the superior thyroid arteries, thyroid
artery, and laryngeal, tracheal and oesophageal arteries.
▪The parathyroid veins drain into the thyroid plexus of veins.

5. ▪Lymphatics
▪The lymphatic vessels of the parathyroid glands drain (along with
those of the thyroid gland) into the deep cervical lymph nodes
and paratracheal lymph nodes.
▪Nerves
▪The parathyroid glands have an extensive supply of nerves,
derived from thyroid branches of the cervical (sympathetic)
ganglia.
▪It is important to note that these nerves are vasomotor, not
secretomotor – endocrine secretion of parathyroid hormone is
controlled hormonally.

6. ▪HYPERPARATHYROIDSM
▪It is a disorder caused by overactivity of one or more of
the parathyroid gland resulting in overproduction of
parathormone. Over production of parathormone is
characterised by bone decalcification and development
of renal calculi. [kidney stones] containing calcium.

7. ▪It occurs 2-4 times more often in women than in men
and most common in people between 60-70 years of
age.
▪The disorder is rare in children younger than 15 yrs. of
age but incidence increases tenfold between the ages
of 15 to 65 years.

8. ▪There are three main types of hyperparathyroidism.
▪Primary hyperparathyroidism means the underlying problem starts in the
parathyroid glands. Secondary and tertiary hyperparathyroidism means that
another disease in the body has caused the parathyroid glands to be
overactive.
▪In secondary hyperparathyroidism, there is a signal to the gland to
produce more parathyroid hormone (for example, a low vitaminD level).
▪In tertiary hyperparathyroidism, the glands continue to over-secrete
parathyroid hormone even though the signal is gone. These conditions may
be seen in kidney disease.

9. ▪In the majority of cases the cause of hyperparathyroidism is not
known. In most people, hyperparathyroidism occurs sporadically.
▪In some cases, however, there can be a genetic basis for developing
the disorder. A rare inherited syndrome called familial multiple
endocrine neoplasia type 1 is associated with hyperparathyroidism.
▪In some cases, all four of the parathyroid glands are somewhat
enlarged and secrete excessive amounts of hormones. This is referred
to as hyperplasia.

10. ▪ Excessive calcium may cause high blood
pressure or hypertension. Symptoms are often
described as "moans, stones, groans, and
bones".
▪ Moans (gastrointestinal conditions)
▪ Constipation
▪ Nausea and vomiting
▪ Decreased appetite
▪ Abdominal pain
▪ Peptic ulcer disease
▪ Frequent heartburn
▪ Stones (kidney-related conditions)
▪ Kidney stones
▪ Groans (psychological conditions)
▪ Confusion
▪ Dementia
▪ Memory loss
▪ Depression
▪ Personality changes
▪ Bones (bone pain and bone-related
conditions)
▪ Bone aches and pains
▪ Fractures
▪ Curving of the spine and loss of height
▪ Flank pain

11. ▪Blood tests. calcium levels in the blood are elevated, and the blood PTH
levels are also inappropriately high for the serum calcium
▪X-rays of bone structures may reveal fractures and other changes in bone.
▪Bone mineral density test.

12. ▪Computerized tomography (CT) scan.
▪Ultrasound.
▪Urine collection.
▪25-hydroxy-vitamin D blood test.
This test is recommended because vitamin D deficiency is common in
people with primary hyperparathyroidism.

13. ▪Drug therapy can include medications that inhibit bone
resorption, such as bisphosphonates and oestrogen plus
progestin, or vitamin D analogues,
▪Thiazide, a specific type of diuretic that may be prescribed for
patients with very high calcium levels.
▪Physical activity, moderate vitamin D and calcium intake should be
coupled with monitoring disease progression with tests such as
serum calcium, creatinine, and bone density.

14. ▪Surgery is indicated if the patient has very high calcium levels, or if the person is
symptomatic with renal stones, multiple fractures, or has osteoporosis.
▪Minimally invasive parathyroidectomy. This type of surgery, which can be
done on an outpatient basis, may be used when only one of the parathyroid
glands is likely to be overactive. Guided by a tumour-imaging test, the surgeon
makes a small incision in the neck to remove the gland. The small incision means
that patients typically have less pain and a quicker recovery than with more
invasive surgery. Local or general anaesthesia may be used for this type of
surgery.

15. ▪Standard neck exploration. This type of surgery involves
a larger incision that allows the surgeon to access and
examine all four parathyroid glands and remove the
overactive ones. This type of surgery is more extensive
and typically requires a hospital stay of 1 to 2 days.
Surgeons use this approach if they plan to inspect more
than one gland. General anaesthesia is used for this type
of surgery.

16. ▪Monitor serum potassium, calcium, phosphate and magnesium levels
because these values may change abruptly during treatment.
▪Encourage the patient to regular exercise, including strength training,
helps maintain strong bones. Because the patient is predispose to
pathologic fracture, take safety precautions to minimize risk of injury.
▪Assist the patient with walking, keep bed at its lowest position and raise
side rails.
▪Lift immobilized patient carefully to minimize bone stress.
▪Encourage the patient to drink plenty of water.

17. ▪Drink at least six to eight glasses of water daily to lessen the risk
of kidney stones.
▪Instruct the patient to avoid calcium- raising drugs
▪Certain medications, including some diuretics and lithium, can
raise calcium levels.
▪Administer oestrogen to postmenopausal women who are not able
to undergo surgery. Oestrogen may preserve bone mass and reduce
calcium levels.

18. ▪Hypoparathyroidism is an uncommon condition in which
body secretes abnormally low levels of parathyroid hormone
(PTH). PTH is key to regulating and maintaining a balance
of body's levels of two minerals calcium and phosphorus.
▪The low production of PTH in hypoparathyroidism leads to
abnormally low calcium levels in blood and to an increase
of phosphorus in blood.

19. ▪Recent neck surgery, particularly if the thyroid was
involved
▪A family history of hypoparathyroidism
▪Having certain autoimmune or endocrine conditions

20. ▪Post-surgical hypoparathyroidism.
▪Autoimmune disease. Immune system creates antibodies
against the parathyroid tissues, trying to reject them as if they
were foreign bodies. In the process, the parathyroid glands stop
manufacturing their hormone.
▪Hereditary hypoparathyroidism.
▪Extensive cancer radiation treatment of face or neck.

21. ▪ Tingling or burning (paraesthesia) in fingertips, toes and lips
▪ Muscle aches or cramps in legs, feet, abdomen or face
▪ Twitching or spasms of muscles, particularly around mouth, but also in hands, arms and
throat
▪ Fatigue or weakness
▪ Painful menstruation
▪ Patchy hair loss
▪ Dry, coarse skin
▪ Brittle nails
▪ Depression or anxiety

22. ▪History collection
▪Physical examination
▪Blood Tests
▪A low blood-calcium level, low parathyroid hormone level,
high blood-phosphorus level, low blood- magnesium level
▪X-Ray

23. ▪ Oral calcium carbonate tablets. Oral calcium supplements can increase calcium levels
in blood. However, at high doses, calcium supplements can cause gastrointestinal side
effects, such as constipation, in some people.
▪ Vitamin D. High doses of vitamin D, generally in the form of calcitriol, can help body
absorb calcium and eliminate phosphorus.
▪ Parathyroid hormone (Natpara). The Food and Drug Administration has approved this
once-daily injection for treatment of low blood calcium due to hypoparathyroidism.
Because of the potential risk of bone cancer (osteosarcoma), at least in animal studies, this
drug is available only through a restricted program to people whose calcium levels can't be
controlled with calcium and vitamin D supplements.

24. Diet
▪ Rich in calcium. This includes dairy products, green leafy vegetables, broccoli and foods
with added calcium, such as some orange juice and breakfast cereals.
▪ Low in phosphorus. This means avoiding carbonated soft drinks, which contain
phosphorus in the form of phosphoric acid, and limiting meats, hard cheeses and whole
grains.
Monitoring
▪ Blood tests, because hypoparathyroidism is usually a long-lasting (chronic) disorder,
treatment generally is lifelong, as are regular blood tests to determine whether calcium
in particular is at normal levels. Doctor will adjust dose of supplemental calcium if
blood- calcium levels rise or fall.

25. ▪ Reversible complications
▪ Tetany.
▪ Paraesthesia
▪ Loss of consciousness with convulsions.
▪ Malformed teeth, affecting dental enamel and
roots.
▪ Heart arrhythmias and fainting, even heart
failure.
▪ Irreversible complications
▪ Stunted growth (short stature)
▪ Slow mental development in children
▪ Calcium deposits in the brain, which can
cause balance problems and seizures
▪ Cataracts

26. ▪There are no specific actions to prevent hypoparathyroidism.
If
had surgery involving thyroid or neck, watch for signs and
symptoms that could indicate hypoparathyroidism, such as a
tingling or burning sensation in fingers, toes or lips, or
muscle twitching or cramping. If they occur, doctor might
recommend prompt treatment with calcium and vitamin D to
minimize the effects of the disorder.

27. ▪ ANSARIAND KAUR “ATEXT BOOK OF MEDICALAND SURGICAL NURSING- 1ST,” PEEVEE
PUBLICATIONS, PAGE NO: 1337-1339
▪ BONITA BOYLES” MEDICAL SURGICAL NURSING CLINICAL COMPANION” PUBLISHEDBY
CAROLINAACADEMIC PRESS. PAGENO:845-848.
▪ BRUNNER AND SUDDARTH, “TEXT BOOK OF MEDICAL AND SURGICAL NURSING”,12TH
EDITION, WOLTER KLUWER INDIA PRIVATE LIMITED, PAGENUMBER:1272-1275.
▪ LEWIS, HEITKEMPER DIRKSEN, “MEDICAL SURGICAL NURSING” 6TH EDITION, MOSBY
PUBLICATIONS, PAGE NO: 1291-1295
▪ S.M. MOGOTLANE ET.AL “JUTAS MANUAL OF NURSING MEDICAL SURGICAL NURSINGPART
2: THE SYSTEMS”, VOLUME 4 JUTA PUBLICATIONS, PAGE NO: 11-1611-19
▪ IGNATIVUS, WORKMAN “MEDICAL AND SURGICAL NURSING” 7TH EDITION,ELSEVIER
PUBLICATIONS, PAGE NO: 653-658

28. ▪SWEARINGENS, “MANUAL OF MEDICAL SURGICAL NURSING” 7TH
EDITION, ELSIVER AND MOSBY PUBLICATIONS, PAGE NO:80-83
▪LINTON, “INTRODUCTION TO MEDICAL SURGICAL NURSING” 4TH
EDITION, ELSIVER PUBLICATIONS, PAGE NO:562-566.
▪USHA RAVINDRAN “TEXT BOOK OF MEDICAL SURGICAL” JAYPEE
PUBLICATIONS PAGE NO: 62-65.
▪LYNDA JUALL CARPENITO {2004} “NURSING CARE PLANS AND
DOCUMENTATION” 4TH EDITION PUBLISHED BY LIPPINCOTT WILLIAMS
AND WILKINS, PAGE NO: 566-568.

29. ▪NET REFERENCES
▪www.onlinelibrary.org
▪Careertrend.com
▪En.wikipedia.org
▪Slideshare.net/medical
surgical nursing
▪www.webmed.org
▪JOURNEL REFERENCE
▪www.nejm.org
▪Www.ncbi.nlm.nih.gov.org
▪https://scholar.google.co.in
▪http://www.nursingworld.org
▪http://journals.lww.com