DEFINITION
- Result is form abnormally low PTH levels. The most common cause is damage to or removal of the parathyroid glands during thyroiddectomy. The lack of circulating PTH causes hypocalcemia and an elevated blood phosphate level.
What is the causes of hypoparathyroidism??
- i) Acquired hypoparathyroidism
- Damage or removal of parathyroid glands.
- ii) Hereditary hypoparathyroidism
- Parathyroid glands not present at birth or they don't work properly.
- iii) Autoimmune disease
- Antibodies against the parathyroid tissues.
- iv) Extensive cancer radiation treatment
- Face or neck, radioactive iodine treatment for hyperthyroidism.
- v) Low levels of magnesium in blood
- Disturb function of parathyroid glands.
RISK FACTOR OF HYPOPARATHYROIDISM
- Recent neck surgery, particularly if the thyroid was involved
- A family history of hypothyroidism
- Having certain autoimmune or endocrine conditions, such as Addison's disease
PHATOPHYSIOLOGY
- Hypoparathyroidism occurs when the body does not have enough circulating parathyroid hormone (PTH) or decrease action of PTH it can either cause a decrease in serum calcium levels (hypocalcemia) and increase in serum Phosphorus levels (hyperphosphatemia) .
- The calcium and phosphorus have a reciprocal relationship in the body.
- Although the majority of cases of hypoparathyroidism are due to hypocalcemia.
CLINICAL MANIFESTATION OF HYPOPARATHYROIDISM
- Musculoskeletal system
- Muscle spasms
- Facial grimacing
- Carpopedal spasms
- Tetany and convulsions
- Integumentary system
- Brittle nails
- Hair loss
- Dry scaly skin
- Gastrointestinal system
- Abdominal cramps
- Malabsorption
- Cardiovascular system
- Arrhythmias
- Central nervous system
- Paresthesias ( lips, hand , feet)
- Anxiety, depreassion and irritability
- Hyperactive reflexes
- Psychosis
- Increase intracranial pressure
DIAGNOSTIC TEST
- Blood test
- Blood elevated serum calcium
- Increased serum phosphate
- Elevated PTH levels
- Urine test
- Elevated urinary cyclic adenosine monophosphate.
TREATMENT FOR HYPOPARATHYROIDISM
Treatment of hypoparathyroidism focuses on increasing calcium levels. Intravenous gluconate is given immediately to reduce tetany. Long term therapy includes supplemental calcium, increased dietary calcium, and vitamin D therapy.
COMPLICATION
- Tetany
- Cramps like spasms to your hands and fingers may be prolonged and painful.
- Paresthesias
- Characterized by sensory symptoms of add, tingling sensations in the tongue, lips, fingers and feet.
- Loss of consciousness with convulsion
- Malformation of the teeth
- Impaired kidney function
- Heart arrhythimias and fainting
NURSING MANAGEMENT
- . Care of postoperative patients who have undergone thyroidectomy, parathyroidectomy, or radical neck dissection is directed toward detecting early signs of hypocalcemia and anticipating signs of tetany, seizures, and respiratory difficulties.
- . Calcium gluconate is kept at the bedside with equipment necessary for emergency IV administration. If the patient requiring administration of calcium gluconate has a cardiac disorder, is subject to dysrhythmias, or is receiving digitalis, the calcium gluconate is administered slowly and cautiously.
- . Calcium and digitalis increase systolic contraction and also potentiate each other; this can produce potentially fatal dysrhythmias. Consequently, the cardiac patient requires continuous cardiac monitoring and careful assessment.
