NCLEX Review Guide: Parathyroid Gland Problems

Normal Parathyroid Function

• Four small glands located on the posterior thyroid that secrete parathyroid hormone (PTH) to regulate calcium and phosphorus balance.
• PTH increases serum calcium by promoting bone resorption, increasing intestinal calcium absorption, and enhancing renal calcium reabsorption while decreasing phosphorus reabsorption.

Pathophysiology & Clinical Manifestations

• Hyperparathyroidism results in excessive PTH secretion causing hypercalcemia and hypophosphatemia. Primary form usually caused by parathyroid adenoma or hyperplasia.
• Classic symptoms remembered by "stones, bones, groans, and psychiatric overtones" - kidney stones, bone pain, GI upset, and mental status changes.
• Cardiovascular effects include shortened QT interval, dysrhythmias, and potential cardiac arrest with severe hypercalcemia.

Causes & Clinical Manifestations

• Most commonly occurs after thyroid or parathyroid surgery due to accidental removal or damage to parathyroid glands, resulting in hypocalcemia and hyperphosphatemia.
• Acute hypocalcemia manifests as neuromuscular irritability including tetany, laryngospasm, and seizures - life-threatening complications requiring immediate intervention.

Assessment Techniques

1. Chvostek's Sign: Tap facial nerve anterior to ear - positive if facial twitching occurs
2. Trousseau's Sign: Inflate BP cuff above systolic pressure for 3 minutes - positive if carpopedal spasm occurs
3. Monitor for prolonged QT interval on ECG indicating cardiac irritability

Hyperparathyroidism Care

• Encourage fluid intake of 3-4 liters daily to prevent kidney stone formation and promote calcium excretion through dilute urine.
• Implement fall precautions due to bone demineralization and muscle weakness; avoid high-calcium foods and thiazide diuretics that increase calcium retention.

Hypoparathyroidism Care

• Emergency treatment for severe hypocalcemia includes IV calcium gluconate 1-2 ampules in 50-100 mL normal saline over 10-20 minutes.
• Maintain quiet environment to reduce stimuli that could trigger tetany; keep tracheostomy tray and resuscitation equipment readily available for laryngospasm.

• Hyperparathyroidism medications include bisphosphonates (alendronate) to reduce bone resorption and calcimimetics (cinacalcet) to decrease PTH secretion.
• Hypoparathyroidism requires lifelong calcium carbonate and calcitriol (active vitamin D) supplementation with regular monitoring of serum calcium levels.

Self-Assessment Checklist

• ☐ Can I differentiate between hyper- and hypoparathyroidism signs?
• ☐ Do I know normal calcium values and inverse phosphorus relationship?
• ☐ Can I perform and interpret Chvostek's and Trousseau's signs?
• ☐ Do I understand emergency treatment for severe hypocalcemia?