#parathyroid

Parathyroidectomies are not to be trusted. Sometimes they can be these wonderfully short, satisfying procedures (30-45min), or so I’m told. The other option is they last hours and hours. So far I’ve only seen cases of the latter.

Retracting is actually quite important because ENT surgeries happen in small spaces/incisions. Yay, I’m helping!

Neck muscle anatomy is still an area for personal improvement.

Bone Builders

As we get older our bones lose density, making them more likely to fracture. Maintaining bone density relies on interactions between different cell types in our bones via the protein Notch. Researchers explore whether injecting adult mice with a protein that binds and activates Notch in bone cells — Dll4(E12) — can increase bone formation. Male mice benefited from this treatment but, because they have less bone surface, females did not. However, when female mice were injected with Dll4(E12) plus a hormone PTH used to treat women with brittle bone disease (osteoporosis) bone density was significantly improved, as revealed through micro-CT of their bones. Compared with untreated bones (far left), and bones treated with either Dll4(E12) or PTH (middle two), females that received both had denser bone (far right). Bone-targeted proteins that activate Notch may therefore prove useful in treating osteoporosis and other conditions that reduce bone density.

Written by Lux Fatimathas

Image from work by Cong Xu and Van Vuong Dinh, and colleagues

Max Planck Institute for Molecular Biomedicine, Department of Tissue Morphogenesis, and University of Münster, Faculty of Medicine, Münster, Germany

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in eLife, February 2022

Parathyroid glands are four small glands of the endocrine system which regulate calcium and phosphate. They are located in the neck behind the thyroid.

Parathyroids are NOT related to the thyroid (just neighbours). however they share a similar blood supply, venous drainage, and lymphatic drainage.

You can easily live with one (or even 1/2) parathyroid gland.

Function

Parathyroid glands control calcium and phosphate levels by producing Parathyroid Hormone (PTH). 

Calcium:

PTH increases blood calcium levels by directly stimulating osteoblasts and thereby indirectly stimulating osteoclasts (through RANK/RANKL mechanism) to break down bone and release calcium.

 PTH increases gastrointestinal calcium absorption by activating vitamin D, and promotes calcium conservation (reabsorption) by the kidneys.

Phosphate:

PTH is the major regulator of serum phosphate concentrations via actions on the kidney. 

Inhibites of proximal tubular reabsorption of phosphorus. 

Activates vitamin D - absorption (intestinal) of Phosphate is increased.

Hypoparathyroidism

Decreased function of the parathyroid glands with underproduction of parathyroid hormone. 

Lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary muscle contraction), and other symptoms. 

Can be inherited, but it is also encountered after thyroid or parathyroid gland surgery, and it can be caused by immune system-related damage 

The treatment of hypoparathyroidism is limited as there is no exact form of the hormone that can be administered as replacement. 

Hi, wow. I meant to do this more often, but I got distracted. Oops. Anyway! 

Let’s start on what the parathyroid is and what it does. 

This little gland here regulates the calcium and phosphorus balance in your body. Increased parathormone elevates blood calcium by increasing calcium absorption from the kidney, intestine, and bone while also lowering phosphorus levels. This means that these two electrolytes are inversely correlated. 

On to the fun part: dysfunction.

Hypoparathyroidism

Hyposecretion of parathormone (PTH) causes hypocalcemia and hyperphosphatemia.

Causes:

Destruction of parathyroid glands (i.e., parathyroidectomy)

Renal failure

Autoimmune complications

Manifestations: 

Muscle cramps -- typically in the abdomen and extremities

Anxiety

Positive Trousseau’s or Chvostek’s sign 

Tetany

Nursing Interventions:

Monitor for signs and symptoms of hypocalcemia and tetany

S/S of hypocalcemia

numbness and/or tingling of the extremities

muscle cramps/spasms

seizures

facial twitching

muscle weakness

lightheadedness

slow heart rate 

Seizure precautions

Airway protection -- intubate with tetany

Calcium-gluconate and vitamin D2

Hyperparathyroidism

Hypersecretion of PTH causes hypercalcemia and hypophosphatemia.

Causes:

Primary

noncancerous growth -- adenoma

cancerous growth

Secondary

Renal failure

hypocalcemia -- overworked parathyroid

phosphorus rentention

Manifestations:

Fatigue

Muscle weakness

Skeletal pain/tenderness

Constipation

Bone Deformities

Renal Stones -- due to frequent urination

Pathological fractures

Anorexia/Nausea/Vomiting

Cardiac dysrhythmias

Interventions:

Monitor vital signs and EKG

Strict I&Os

Skeletal pain management

Avoid injury

Parathyroidectomy care

Encourage movement

Patient education

That’s really all I have for you in terms of the parathyroid and nursing care! I hope this helps. If anyone has anything to add, please feel free!