The document outlines a seminar on disorders of the parathyroid glands presented by Ms. Gautami S. Tirpude. It discusses the general and specific objectives of gaining knowledge about parathyroid gland disorders and their application in nursing practice. The seminar covers topics like hyperparathyroidism and hypoparathyroidism including their definition, etiology, pathophysiology, clinical manifestations, diagnostic studies, and medical and surgical management. It also discusses the nursing role in managing related complications through various nursing interventions.

1. SEMINAR ON
“DISORDERS OF THE
PARATHYROID GLANDS”
BY,
Ms. Gautami S. Tirpude
F.Y.M.Sc Nursing,
B.V.C.O.N, Pune.

2.  General objectives-
 At the end of the seminar, the group will
be able to gain depth knowledge
regarding different Parathyroid glands
disorders and they will be able to apply
this knowledge in their nursing practices.

3.  Specific Objective-
 The students will be able to-
 Define disorders of parathyroid glands
 Classify hyperparathyroidism
 Describe hyperparathyroidism
 Explain hypothyroidism
 Enlist etiology of Parathyroid gland disorders
 Explain the pathophysiology of Parathyroid gland
disorders
 List down the clinical manifestation of
Parathyroid gland disorders
 Explain the role of nurse in management of
Parathyroid gland disorders
 Elaborate primary hyperthyroidism recent
researches

4. OUTLINE-
 Introduction
 Definition of parathyroid gland disorders
 Review anatomy and physiology of
parathyroid glands
 Definition of Hyperparathyroidism
 Definition of Hypoparathyroidism
 Etiology
 Risk factors
 Incidence
 Pathophysiology
 Clinical manifestations

5.  Diagnostic studies
 Management: Goals
 Medical Management- a)Pharmacological,
Diet and Therapeutic Management
 Surgical Management- b)Pre-operative, Intra-
operative and Post-operative management
 Nursing Management-a) Nursing Process
and Nursing management
 Complications
 Prevention
 Health Education
 Current trends
 Summary
 Conclusion
 Bibliography

6. INTRODUCTION
 Disorders of the parathyroid glands most commonly
present with abnormalities of serum calcium. Patients
with primary hyperparathyroidism, the most common
cause of hypercalcemia in outpatients, are often
asymptomatic or may have bone disease, nephrolithiasis,
or neuromuscular symptoms. Hypoparathyroidism most
often occurs after neck surgery; it can also be caused by
autoimmune destruction of the glands and other less
common problems.

7. Disorders of the Parathyroid
Glands
Definition: When the parathyroid gland
dysfunctions, hyperparathyroidism or
hypoparathyroidism develops.
Calcium and phosphorous levels are
affected.

8. Review of Anatomy and
Physiology of Parathyroid
Gland

9. FUNCTION:
 secrete parathyroid hormone(PTH,
parathormone).
 -regulates the blood calcium level.
 -PTH raises the blood calcium level by:
 Increased calcium absorption from the bones,
kidney and intestine, which raises the serum
calcium level.
 Increased serum calcium results in
decreased parathormone secretion, creating
a negative feedback system.

11. HYPERPARATHYROIDISM
 Definition:
 The presence of excess parathyroid
hormone in the body resulting in
disturbance of calcium metabolism
with increase in serum calcium,
characterized by bone decalcification
and the development of renal calculi
(kidney stones) containing calcium.

12. Classification:
 Hyperparathyroidism can be a
 primary
 secondary and
 Tertiary condition.

13. PRIMARY
HYPERTHYROIDISM
-In primary hyperparathyroidism, excessive
secretion of parathyroid hormones results in
increased urinary excretion of phosphorus and
loss of calcium from the bones.
-The bones become demeneralized as the
calcium leaves and enters the bloodstream.

14.  Etiology
An adenoma of one of the parathyroid glands
- occurs two to four times more often in women than
in men and is more common in people between 60
and 70 years of age.

16. Secondary
hyperparathyroidism
-In secondary hyperparathyroidism, the
parathyroid gland secrete an
excessive amount of parathyroid
hormone in response to hypocalcemia
(low serum calcium level)

17. Etiology
 vitamin D deficiency,
 chronic renal failure,
 large doses of thiazide diuretics,
 and excessive use of laxatives and
calcium supplements.

18. Tertiary hyperparathyroidism
- If the parathyroid glands continue to
produce too much parathyroid
hormone even though the calcium
level is back to normal, the condition is
called “tertiary hyperparathyroidism”.

19. PATHOPHYSIOLOGY
Parathyroid glands help to regulate calcium levels in the body
if calcium levels are low
Parathormone levels increase and vice versa
Parathormone regulates calcium by influencing absorption in
the GI tract, excretion in the urine and release from the
bones

20. Calcium level in the blood increase
Calcium from bones enter blood stream causing blood to
have too much calcium
Results in high blood pressure and kidney stones
If too much parathormone is released, calcium regulation
is disrupted

21. RISK FACTORS
 Are a woman who has gone through
menopause.
 Have had prolonged, severe calcium
or vitamin D deficiency, because
vitamin D helps body absorb the
calcium in bloodstream.
 Have taken lithium drug.

22. INCIDENCE:
 Its incidence is approximately 25
cases per 100,000 people. The
disorder is rare in children younger
than 15 years, but its incidence
increases between the ages of 15 and
65 years.

23. DIAGNOSTIC FINDINGS
 X-ray

24.  The double-antibody parathyroid
hormone test is used to distinguish
between primary hyperparathyroidism
and malignancy
 An MRI or a CT scan

25. MANAGEMENT

26. GOAL
 The goal is to relieve symptoms and
prevent complications caused by
excess Parathyroid hormone.

27. 1. MEDICAL MANAGEMENT
Pharmacological management:
 -If patient have mildly increased calcium levels
due to primary hyperparathyroidism and no
symptoms, just needs regular checkups with
doctor.
 - Calcimimetics, which turns off the action of
PTH.
 Hormone replacement therapy- may help bones
retain calcium
 Bisphosphonates

28. Dietary management:
 a diet with restricted or
excess calcium.
 limit intake of calcium
(aim for less than 1,200
mg each day) and
vitamin D (aim for less
than 600 IU each day)
protein feedings are
necessary.
 Prune juice, stool
softeners, increased fluid
intake to prevent kidney

29. Therapeutic management:
Hydration therapy:
 A daily fluid intake of
2000 ml or more is
encouraged to help
prevent calculus
formation.
Mobility:
 The nurse encourages
the patient to be mobile.
Bones subjected to the
normal stress of working
give up less calcium.
Bed rest increases
calcium excretion and

30. SURGICAL MANAGEMENT:
PRE-OPERATIVE CARE
-Check doctor’s order.
-Identify the patient.
-Explain the procedure to the
patient.
-Prepare the patient for surgery.

31. INTRA-OPERATIVE CARE
 Assess the condition of the patient
 Vital signs monitoring
 Assesses the amount of blood loss
 Ensures that the surgical team maintains
sterile technique and a sterile field
 Anticipates the client's and surgical
team's needs, pro
viding supplies and equipment as
needed
 Communicates information regarding the
client's status
with family members during long and
unique procedures
 Documents care, events, interventions,
and findings

32.  POST-OPERATIVE CARE
-Airway management
-Monitor serum calcium
-Assess symptoms- anxiety, hyperventilation,
Chvostek’s and Trousseau’s signs, paresthesias.
-Administer oral calcium carbonate 1 g per oral q6h,
or IV calcium gluconate for severe
hypocalcemia(<7.0)
-Vitamin D supplementation
-Watch out for bleeding and infection

33. NURSING MANAGEMENT:
 Intake and output
 Observe for signs of urinary calculi, flank
pain and decreasing urine output
 Monitor serum potassium, calcium,
phosphate and magnesium levels.
 Encourage a large volume of fluid.
 Encourage the patient to regular
exercise.
 Assess the patient with walking, keep
bed at its lowest position and raised side
rails.
 Lift immobilized patient carefully to
minimize bone stress.

34. COMPLICATION:
HYPERPARATHYROIDISM:
 Osteoporosis
 Kidney stones
 Cardiovascular disease
 Neonatal hypoparathyroidism:
severe untreated hyperparathyroidism
in pregnant women may cause
dangerously low levels of calcium in
newborn

35. DEFINITION:
 Hyperparathyroidism occurs when
either insufficient levels of parathyroid
hormone are released by the
parathyroid gland in the neck. It leads
to low levels of calcium
(hypocalcaemia) and high level of
phosphorous in the blood
(hyperphosphatemia).

36. ETIOLOGY:
 Abnormal parathyroid development
 Trauma to the glands
 Near total removal of the thyroid gland
 Destruction of parathyroid glands
(surgical removal or auto immune
response) and vitamin D deficiency.

37. RISK FACTORS
 Recent neck surgery, particularly if the
thyroid was involved
 A family history of hypoparathyroidism
 Addison’s disease
 Drugs (cimetidine, aluminium,
doxorubicin)
 Metal (iron, magnesium, aluminium)
overload
 Magnesium deficiency due to alcoholism,
malnutrition

38. INCIDENCE:
 115000 patients in the united states
having hypoparathyroidism of any
cause
 Hypoparathyroidism was caused by
neck surgery in 78% of cases, other
secondary causes in 9%, familial
disorders in 7% and without an
identified caused in 6%

39. PATHOPHYSIOLOGY
 Due to cause-trauma to glands, surgery, or
congenital absence of parathyroids
 Deficiency of parathormone
 Results in hypocalcemia
 Affects neuromuscular function
 Causes hyperexcitibility
 Results in spastic muscle contractions and
paresthesias

40. CLINICAL MANIFESTATIONS
 Tingling, numbness or burning (paresthesias) in
finger tips, toes and lips
 Muscle ache or cramp affecting legs, feet,
abdomen or face
 Twitching or spasm of muscles, around mouth but
also in hands, arms and throat
 Dry hair, brittle nails, dry course skin, loss of
memory
 Severe muscle spasm (also called tetany) and
convulsion
 Anxiety, nervousness, depression, mood swings
 Cardiac dysarrhythmia,
 Carpopedal spasm(flexion of the elbows and wrists
and extension of the carpophalangeal joints and
dorsiflexion of the feet)
 Laryngeal spasm, hoarsenesss

42. DIAGNOSTIC FINDINGS:
 Taking medical history, and asking about
symptoms.
 Conducting Physical examination.
 Radioimmunoassay for Parathyroid hormone
shows diminished serum Parathyroid
hormone concentration.
 Blood and Urine tests reveal decreased
serum and urine calcium levels, increased
serum phosphate levels(more than 5.4 mg/dl)
 X-rays indicate greater bone density and
malformation.
 ECG changes disclose increased QT and ST
intervals due to hypocalcemia

43. MANAGEMENT:
 GOALS: The goal of management for
hypoparathyroidism is to restore the
bodies calcium and phosphorous to
normal level and reduce further
complications.

44. 1.MEDICAL MANAGEMENT:
PHARMACOLOGICAL MANAGEMENT:
 Oral calcium carbonate and vitamin D
supplement are usually lifelong therapy
 Vitamin D supplement are needed because
vitamin D also help to regulate calcium level.
 Administration of IV calcium salt such as
calcium glucoanate
 Bronchodilators are also used.
 Long term treatment after trauma to all in
advertent removal of the parathyroids include
administration of oral calcium and vitamin D.

45. DIETARY MANAGEMENT:
 A high calcium and vitamin D, low
phosphorous diet is recommended
 High calcium diet includes dairy
products, green leafy vegetables,
broccoli, fortified orange juice and
breakfast cereals.
 Instruct the patient to avoid
carbonated soft drinks which contain
phosphorous in the form of phosphoric
acid
 Eggs and maize also tend to be high
in phosphorous.

46. NURSING MANAGEMENT
 Detect early signs of hypocalcemia and
anticipating signs of tetany, seizures and
respiratory difficulties
 Calcium gluconate should be available for
emergency, IV administration
 Be alert for signs of tetany. Assess for
Chvostek’s and Trousseau’s signs
 Keep an emergency tracheostomy tray,
mechanical ventilation equipment, artificial
airway and endotracheal intubation
equipment.
 Observe the client at frequent intervals for
respiratory disease.

47. NURSING PROCESS
Acute pain related to excessive
deposition of calcium secondary to renal
calculi as evidenced by patient’s report
of pain.
Activity intolerence related to fatigue,
muscle weakness , and pain as
evidenced by not able to perform daily
activities.
Imbalanced nutrition less than body
requirements related to muscle
weakness or inability to absorb as
evidenced by less intake of food.

48.  Knowledge deficit related to new
condition, procedure , treatment
related as evidenced by frequent
asking of questions.
 Fear and Anxiety related to surgery as
evidenced by patient’s report of fear.

49. COMPLICATIONS
 Cataract: is a condition characterized
by clouding of the lens of the eye
 Calcium deposit in the brain
 Stunted growth in children
 Slow mental development in children

50.  Teach effects of disease
 the planned medical management and
the importance of following the
prescribed treatment
 Ask patient to consult with the
dietician which is necessary to provide
a list of foods to include or avoid in the
diet
 Instruct patient to take the medicine as
prescribed by the doctors

51.  Current Concepts in the Presentation, Diagnosis and
Management of Primary Hyperparathyroidism
 by Amal Alhefdhi
 Conclusions: PHPT occurs at any age, but it is most
commonly seen in people over the age of 50 years and
postmenopausal women. The current presentation of
PHPT shifts from the classical symptomatic form to the
asymptomatic form; however, parathyroidectomy is still
the treatment of choice for both symptomatic and
asymptomatic forms. In the past, bilateral neck
exploration and intraoperative identification of all 4
parathyroid glands was the standard of treatment,
nevertheless, nowadays, with the introduction of the
preoperative and intraoperative localization techniques,
the minimally invasive parathyroidectomy has evolved

52. CURRENT AND FUTURE TREATMENT FOR
PARATHYROID CARCINOMA
By Kristin L Long,2018
Conclusion & future perspective
PC remains a rare entity, making widely applicable studies
about prognosis, treatment or recurrence difficult.
Adequate surgical resection is the best initial treatment,
with resection of all tumor and involved structures
necessary for optimal outcomes. Preoperative diagnosis
remains challenging, mandating surgeons maintain a high
index of suspicion for possible malignancy during
parathyroid operations. Adjuvant treatment options are
sporadically used at best, and further study and
innovation is needed to improve options and outcomes. In
the coming years, early recognition, appropriate initial
surgical treatment and close surveillance should be
emphasized as further research works to identify unique
adjuvant therapies for PC. Given the rarity of the disease,
collaborative research will be vital to advance treatment
options.

54. BIBLIOGRAPHY
BOOKS:
 Barbara K.Timby, Jeanne C. Scherer, Nancy
E. Smith,“Introductory Medical surgical
Nursing” ,7th Edition, published by lippincott
Williams and wilkins, page no:813 to 816
 Janice L.Hinkle, Kerry H. Cheever, “Brunner
&Suddarth’s textbook of Medical-Surgical
Nursing” 13th Edition, published by wolters
kluwer, page no:1487 to1490,volume 2
 Javed Ansari, Davinder Kaur, “Textbook of
medical surgical nursing 1”, published by Pee
Vee,page no:1368-1374

55. JOURNALS:
 International Journal of Endocrine
Oncology,Vol. 5, No. 1
 Journal of Surgery, ISSN: 1584-9341
WEBSITES:
 https://www.slideshar.net/mobile/drpriyankash
astri/parathyroid-glands-34486090
 https:www.omicsonline.org/open-
access/current-concepts-in-the-presentation-
diagnosis-and-management-of-primary-
hyperparathyroidism-1584-9341-11-1-
1.php/aid=38113
 https://www.parathyroid.com/parathyroid-
symptoms.htm