Which medication would most likely be ordered for the client with hypoparathyroidism?

The Department of Otolaryngology at the University of Michigan is a leader in diagnosing, treating and rehabilitating patients with thyroid and parathyroid diseases, one of the five areas that otolaryngology treats. In addition, patients with these disorders are cared for by experts from endocrinology, endocrine surgery, nuclear medicine, radiation and medical oncology, radiology, genetics, and pathology.

University of Michigan's team of multidisciplinary specialists is focused on reaching accurate diagnosis through comprehensive testing and providing the best treatment options for each patient. We are often referred patients with very complex issues and are constantly evaluating latest research findings with newest techniques and therapies to offer our patients the best care possible.

About Thyroid and Parathyroid Disorders

Thyroid disorders typically occur when the thyroid gland (a small, butterfly-shaped gland located in the lower portion of the neck) releases too many or too few hormones. Imbalance of this kind can create disturbance in the functions that regulate how the body metabolizes proteins, fats and carbohydrates as well as in how it ​uses energy, consumes oxygen and produces heat. Production of thyroid hormone by the thyroid gland is regulated by another hormone that is made by the pituitary gland, a small gland in the base of your brain. The pituitary and thyroid glands work together to produce the right amount of thyroid hormone for the body. If too little thyroid hormone is produced, people are considered hypothyroid; if thyroid hormone is produced in excess, they are diagnosed as hyperthyroid.

Parathyroid disorders develop when parathyroid glands (normally four glands located near, or attached to, the back surface of the thyroid) release inappropriate levels of PTH​ hormone which controls calcium levels in the body. Hyperparathyroidism is a condition caused by higher than normal calcium levels (parathyroid glands producing too much PTH​) and can lead to negative effects like osteoporosis, kidney stones, chronic fatigue and others. The opposite problem, hypoparathyroidism, occurs when parathyroid glands do not produce enough PTH, leading to low blood calcium levels and adversely affecting muscles, nerves and other functions.

Diagnosis of Thyroid and Parathyroid Disorders

Our specialists diagnose thyroid and parathyroid disorders through comprehensive testing that starts with a complete history and physical exam, and is followed by blood work, an important step in identifying the disorder.

Depending on the specific problem, we may conduct an ultrasound of the neck to identify abnormalities. Ultrasounds also allow us to guide a needle biopsy, if necessary, to evaluate nodules or lymph nodes in the neck. Other imaging tests that may be ordered include CAT scan, MRI, and nuclear medicine tests such as radioiodine scans and PET scans.

Treatment for Thyroid and Parathyroid Disorders

At the University of Michigan, each patient is carefully evaluated by our team of experts so the best decision can be made on the most appropriate course of treatment. Deciding which treatment is best for each patient depends on the cause and severity of the disease, as well as a number of other factors.

We see patients with a wide range of thyroid disorders, including:

  • Thyroid nodules are growths or lumps in the thyroid gland. They are fairly common and can be found in a normal size or enlarged thyroid gland. Around 95% of nodules are benign, or non-cancerous, in which case no specific treatment is needed, and the thyroid can simply be followed to make sure the nodules don't become a problem over time. If your physician is concerned that your nodule may be cancerous or is large enough to cause problems with breathing or swallowing, surgery may be recommended.
  • Hyperthyroidism is a disorder caused by an overactive thyroid that causes the body to speed up. It can cause weight loss, a faster heartbeat, sweating, or feelings of nervousness. Graves’ Disease is one of the main causes of hyperthyroidism. It is an autoimmune disease, more common in women than men, and can be associated with a special type of eye abnormality (Graves’ eye disease). If untreated, hyperthyroidism can lead to serious heart, bone and other problems. The most common treatments for hyperthyroidism are anti-thyroid medicine and radioactive iodine.
  • Hypothyroidism is a disorder caused by an under-active thyroid that may lead to changes in the hair or skin, fatigue and weakness, memory problems, or other issues. Hashimoto’s Thyroiditis, also known as Hashimoto’s disease, is an autoimmune disease that causes the body’s immune system to produce antibodies that attack thyroid tissue and damage the gland, leading to an under-productive thyroid. Hypothyroidism can usually be easily treated with thyroid hormone medicine, typically levothyroxine, which is identical to the main thyroid hormone made by the thyroid gland.

We treat the following parathyroid disorders:

  • Hypoparathyroidism occurs when the body does not produce enough PTH hormone and calcium levels fall below normal. Hypoparathyroidism is usually treated with a special form of vitamin D (calcitriol) and with calcium tablets. Careful monitoring is required to optimize the dosages.
  • Hyperparathyroidism occurs when the body continues producing PTH hormones even though calcium levels are higher than normal. For primary and tertiary hyperparathyroidism, surgery is the preferred method of treatment. Surgically removing the enlarged or overactive parathyroid can permanently cure the parathyroid disorder, with minimally invasive techniques available for certain patients.
  • Primary Hyperparathyroidism is an increase in calcium levels in the blood caused by the growth of benign, or non-cancerous, tumors on one or more of the parathyroid glands. It causes both the calcium and PTH levels to be above normal.
  • Secondary Hyperparathyroidism is a change in parathyroid function due to Vitamin D deficiency or renal (kidney) failure. Vitamin D deficiency is easily treated with medication and does not require surgery. Secondary hyperparathyroidism due to renal failure can be controlled with medication in some instances but for those patients with extremely high parathyroid hormone levels surgery may be needed to adequately control the condition.
  • Tertiary Hyperparathyroidism is seen in patients who have undergone kidney transplants and have abnormally high parathyroid hormone and calcium levels. 

Quiz that contains NCLEX questions for hypoparathyroidism vs hyperparathyroidism. Hypoparathyroidism and hyperparathryoidism are endocrine disorders of the parathyroid gland. In the previous NCLEX review series, I explained thyroid gland disorders, such as hypothyroidism and hyperthyroidism and how they affect the body along with nursing interventions.

The parathyroid gland is located in the neck on the back of the thyroid gland. Therefore, these two glands are very close to each other and share the same blood supply. In hypoparathyroidism, there is a low production of parathyroid hormone. Whereas as in hyperparathyroidism, there is an excessive amount of parathyroid hormone production.

In hypoparathyroidism and hyperparathyroidism, it is important you know the typical signs and symptoms, causes, and treatments.

The NCLEX exam loves to ask questions about patient education, common side effects of medications, and major signs and symptoms the patient can exhibit with hypoparathyroidism.

It is important to be able to distinguish hypoparthryoidism vs hyperparathyroidism.

This quiz will test you on:

  • Causes of hypoparathyroidism vs hyperparathyroidism
  • Signs and symptoms of hypoparathyroidism vs hyperparathyroidism
  • Medications used to treat hypoparathyroidism vs hyperparathyroidism
  • Nursing interventions for hypoparathyroidism vs hyperparathyroidism

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NCLEX Practice Questions for Parathyroidism

1. A patient is recovering from a thyroidectomy. The patient starts to complain of tingling and numbness in the face, toes, and fingers. Which of the following findings below warrants attention?

A. Ca+ level: 6 mg/dL

B. Na+ level: 145 mg/dL

C.  K+ level: 3.5 mg/dL

D. Phosphate level: 4.3 mg/dL

2. Which of the following patients are MOST at risk for hypoparathyroidism?

A. A 75 year-old female who is diabetic and takes Os-Cal daily.

B. A 59 year-old male with a Mg+ level of 0.9 mg/dL.

C. A 85 year-old female complaining of flank pain and constipation.

D. A 19 year-old male with a Ca+ level of 8.9 mg/dL.

3. A patient hospitalized with hypoparathyroidism is about to order lunch. Which food selection is best for this patient based on their dietary needs at this time?

A. Baked chicken, green beans, and boiled potatoes

B. Spinach salad, cottage cheese, and peaches

C. Roast beef, carrots, and pinto beans

D. Hamburger, fries, and sorbet

4. A patient is 6 hours post-opt from thyroid surgery. The patient’s calcium level is 5 and phosphate level is 4.2. What physical signs and symptoms would NOT present with these findings? (Select-all-that-apply)

A. Bronchospasm

B. Constipation

C. Numbness and tingling in the face

D. Positive Chvostek’s Sign

E. Absent Trousseau’s Sign

F. Hypertension

5. A physician orders Calcium Gluconate IV as treatment for a patient with hypoparathyroidism. The patient’s calcium level is 5 mg/dL. Which of the following finding causes you to question this order?

A. The patient is taking Digoxin.

B. The patient complains of muscle cramping and numbness in the face.

C. The patient is taking Aluminum carbonate.

D. The patient’s phosphate level is 7 mg/dL.

6. You are providing discharge teaching to a patient who is prescribed calcium supplements with vitamin D for treatment of hypoparathyroidism. Which of the following statements by the patient warrants you to re-educate the patient on how they should take this medication?

A. “I will also make sure I eat foods rich in calcium, such as dairy and green leafy vegetables while I’m taking this medication.”

B. “A side effect of this medication is constipation. Therefore, I should drink plenty of fluids.”

C. “I will take my calcium supplements in the morning when I take my Synthroid.”

D. All the statements above are correctly stated by the patient.

7. A patient is recovery from a parathyroidectomy. Which of the following findings causes concern and requires nursing intervention?

A. The patient is in Semi-Fowler’s position.

B. The patient’s calcium level is 8.9 mg/dL.

C. The patient’s voice is hoarse.

D. The patient is drowsy but arouses to name.

8. A patient is prescribed Fosamax (Alendronate). The patient is about to be discharged and you observe the patient taking the medication. Which of the following findings requires you to re-educate the patient on how to take this medication?

A. The patient takes the medication on an empty stomach.

B. The patient takes the medication with water.

C. The patient sits up 10 minutes after taking the medication.

D. The patient waits 30 minutes after taking Fosamax before taking the prescribed vitamins and antacids.

9. A patient is diagnosed with hyperparathyroidism. Which of the following signs and symptoms would you NOT find in this patient? Select all that apply:

A. Calcium level 6 mg/dL

B. Bone fracture

C. Positive Trousseau’s Sign

D. Tingling and numbness of lips and fingers

E. Calcium level of 15 mg/dL

F. Phosphate level 1.2

G. Renal calculi

10. Which of the following patients are most likely to experience secondary hyperparathyroidism?

A. A 58 year-old male with chronic renal failure.

B. A 69 year-old female with an adenoma on the parathyroid gland.

C. A 56 year-old male with a magnesium level of 0.5 mg/dL.

D. A 7 year-old with diabetes type 1.

11. This medication is used to treat hyperparathyroidism in patients with chronic renal failure. It works by mimicking the role of calcium in the blood and tricks the parathyroid gland into stop secreting PTH (parathyroid hormone). Which of the following medications does this describe below?

A. Calcitonin

B. Fosamax

C. Lasix

D. Sensipar

Answer Key:

1. A 2. B 3. B 4. B, E, F 5. A 6. C 7. C 8. C 9. A, C, D 10. A 11. D

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