Hypoparathyroidism

Question 1

What is Hypoparathyroidism?

Answer 1

Inadequate circulating PTH

Lack of PTH results in Hypocalcemia (⬇️Ca+)

Question 2

Iatrogenic Hypoparathyroidism

Answer 2

MOST COMMON CAUSE
- Accidental removal of parathyroid gland or damage to blood supply to gland 2/2 Thyroidectomy

• results from absence, fatty replacement, or atrophy of the gland is a RARE disease

Question 3

Pseudo Hypoparathyroidism

Answer 3

Genetic defect resulting in ⬇️ Ca+ (Hypocalcemia) even thought they have ⬇️ PTH or NORMAL PTH levels.

• Due to resistance of PTH at the cellular level

Question 4

Clinical manifestations of Hypoparathyroidism

Answer 4

• Numbness & tingling (lips, finger, feet)
• Tonic Spasms of smooth & skeletal muscles
• Dysphagia
• Laryngospasm
• ⬇️ serum Ca+ & ⬇️ PTH
• ⬆️ Phosphorus

Question 5

Cardiovascular manifestations of Hypoparathyroidism

Answer 5

⬇️ muscle contractility
⬇️ cardiac output
- dysthymia

Prolongation of QT and ST segment

Question 6

Pharmacological management of Hypoparathyroidism

Answer 6

IV calcium chloride, calcium gluconate, or calcium gluceptate
- given slowly
- PC: Hypotension, Cardiac dysthymia, cardiac arrest
- PC: venous irritation, extravasation, inflammation, necrosis, and tissue sloughing
Oral Calcium supplements (1.5-3g/day)
Vitamin D: Calcitrol
⬆️ intestinal Ca+ absorption and bone reabsorption
- raise Ca+ quickly
- quickly metabolized

Question 7

Treatment of Hypoparathyroidism

Answer 7

• EKG monitoring : especially during IV Ca+ administration
• Lower pH: will temporary ⬇️ Hypocalcemia manifestations
• Rebreathing: Paper bag breathing. ⬇️ CO2 excretion from lungs, ⬆️carbonic acid levels in blood, ⬇️ pH
• Diet: (High Calcium Diet) Dark green vegetables, soy beans, tofu

Question 8

Neurological manifestations of Hypoparathyroidism

Answer 8

• irritability
• paresthesia
• tremor & seizures
• (+) Chvostek & Trousseau sign
• hyperactive deep tendon reflexes
• disorientation

Question 9

GI manifestations of Hypoparathyroidism

Answer 9

⬇️ Ca+ = no contractility

• Fecal incontinence (leakage)
• malabsorption
• abdominal cramps

Question 10

Renal manifestations of Hypoparathyroidism

Answer 10

⬇️Ca+ = ⬇️ or no contractility
* you’ll need Ca+ for contractility

• urinary frequency
• urinary incontinence

Question 11

Musculoskeletal manifestations of Hypoparathyroidism

Answer 11

Painful Tonic spasms of smooth & skeletal muscles

• dysphagia
• laryngospams
• this can compromise breathing*

Question 12

Integumentary manifestations of Hypoparathyroidism

Answer 12

• Dry & Scaly skin
• Hair loss (scalp and body)
• Brittle nails
• CHILDREN changes in developing teeth
• Lack of tooth enamel (hard outer surface layer of teeth, protects against tooth decay)