The document discusses disorders of the parathyroid gland. It begins by describing the location and function of the parathyroid glands. It then discusses the anatomy of the parathyroid glands including their location, blood supply, lymphatics, and nerves. The document proceeds to describe hyperparathyroidism including its causes, symptoms, diagnosis, and treatment. It concludes by discussing hypoparathyroidism, its causes, signs and symptoms, and treatment options.

1. DISORDERS OF
PARATHYROID GLAND
THANUJA ELEENA MATHEW

2.  The parathyroid glands are small endocrine glands located in the anterior neck.
They are responsible for the production of parathyroid hormone, which acts to
control calcium levels in the body.
 This article will consider the anatomical location, vessels and nerves of the
parathyroid glands, as well as some clinical correlations.

3. The parathyroid glands are located on the posterior aspect of the lateral
lobes of the thyroid gland. They are flattened and oval in shape,
situated external to the gland itself, but within its sheath.
The majority of people have four parathyroid glands, although
variation in number is common. Anatomically, the glands can be
divided into two pairs:
Superior parathyroid glands – Derived embryologically from the
fourth pharyngeal pouch. They are located approximately 1cm
superior to the entry of the inferior thyroid arteries into the thyroid
gland (at level of the inferior border of the cricoid cartilage).

4. Inferior parathyroid glands – Derived embryologically from the
third pharyngeal pouch. Although inconsistent in location between
individuals, the inferior parathyroid glands are usually found near the
inferior poles of the thyroid gland. In a small percentage of people, the
glands can be found as far inferiorly as the superior mediastinum.
Vascular Supply
The posterior aspect of the thyroid gland is supplied by the inferior
thyroid arteries. Thus, its branches also supply the nearby
parathyroid glands. Collateral circulation is delivered by the superior
thyroid arteries, thyroid artery, and laryngeal, tracheal and oesophageal
arteries.
The parathyroid veins drain into the thyroid plexus of veins.

5. Lymphatics
The lymphatic vessels of the parathyroid glands drain (along
with those of the thyroid gland) into the deep cervical lymph
nodes and paratracheal lymph nodes.
Nerves
The parathyroid glands have an extensive supply of nerves,
derived from thyroid branches of the cervical (sympathetic)
ganglia.
It is important to note that these nerves are vasomotor, not
secretomotor – endocrine secretion of parathyroid hormone is
controlled hormonally.

6. HYPERPARATHYROIDSM
It is a disorder caused by overactivity of one more of
the parathyroid gland resulting in overproduction of
parathormones. Over production of parathormone is
characterized by bone decalcification and
development of renal calculi. [kidney stones]
containing calcium.

7. It occurs 2-4 times more often in women than in men
and most common in people between 60-70 years of
age.
The disorder is rare in children younger than 15 yrs. of
age but incidence increases tenfold between the ages
of 15 to 65 years.

8. There are three main types of hyperparathyroidism.
Primary hyperparathyroidism means the underlying problem starts
in the parathyroid glands. Secondary and tertiary hyperparathyroidism
means that another disease in the body has caused the parathyroid
glands to be overactive.
In secondary hyperparathyroidism, there is a signal to the gland to
produce more parathyroid hormone (for example, a low vitamin
D level).
In tertiary hyperparathyroidism, the glands continue to over-secrete
parathyroid hormone even though the signal is gone. These conditions
may be seen in kidney disease.

9. In the majority of cases the cause of hyperparathyroidism is
not known. In most people, hyperparathyroidism occurs
sporadically.
In some cases, however, there can be a genetic basis for
developing the disorder. A rare inherited syndrome called
familial multiple endocrine neoplasia type 1 is associated
with hyperparathyroidism.
In some cases, all four of the parathyroid glands are
somewhat enlarged and secrete excessive amounts of
hormones. This is referred to as hyperplasia.

10.  Excessive calcium may cause high blood
pressure or hypertension. Symptoms are often
described as "moans, stones, groans, and
bones".
 Moans (gastrointestinal conditions)
 Constipation
 Nausea and vomiting
 Decreased appetite
 Abdominal pain
 Peptic ulcer disease
 Frequent heartburn
 Stones (kidney-related conditions)
 Kidney stones
 Groans (psychological conditions)
 Confusion
 Dementia
 Memory loss
 Depression
 Personality changes
 Bones (bone pain and bone-related
conditions)
 Bone aches and pains
 Fractures
 Curving of the spine and loss of height
 Flank pain
 Frequent urination

11. Blood tests. calcium levels in the blood are elevated, and the blood PTH
levels are also inappropriately high for the serum calcium
X-rays of bone structures may reveal fractures and other changes in bone.
Bone mineral density test. Dual energy x-ray absorptiometry,
sometimes called a DXA or DEXA scan, uses low-dose x rays to measure bone
density

12. Computerized tomography (CT) scan.
Ultrasound.
Urine collection.
25-hydroxy-vitamin D blood test.
This test is recommended because vitamin D deficiency is common in
people with primary hyperparathyroidism.

13. Drug therapy can include medications that inhibit bone
resorption, such as bisphosphonates and oestrogen plus
progestin, or vitamin D analogues,
Thiazide, a specific type of diuretic that may be prescribed
for patients with very high calcium levels.
Physical activity, moderate vitamin D and calcium intake
should be coupled with monitoring disease progression with
tests such as serum calcium, creatinine, and bone density.

14. Surgery is indicated if the patient has very high calcium levels, or if the person
is symptomatic with renal stones, multiple fractures, or has osteoporosis or
bone rumours.
Minimally invasive parathyroidectomy. This type of surgery, which can be
done on an outpatient basis, may be used when only one of the parathyroid
glands is likely to be overactive. Guided by a tumour-imaging test, the surgeon
makes a small incision in the neck to remove the gland. The small incision
means that patients typically have less pain and a quicker recovery than with
more invasive surgery. Local or general anaesthesia may be used for this type
of surgery.

15. Standard neck exploration. This type of surgery involves a
larger incision that allows the surgeon to access and examine
all four parathyroid glands and remove the overactive ones.
This type of surgery is more extensive and typically requires a
hospital stay of 1 to 2 days. Surgeons use this approach if they
plan to inspect more than one gland. General anaesthesia is
used for this type of surgery.

16. Monitor serum potassium, calcium, phosphate and magnesium levels
because these values may change abruptly during treatment.
Encourage the patient to regular exercise, including strength training,
helps maintain strong bones. Because the patient is predispose to
pathologic fracture, take safety precautions to minimize risk of
injury. Assist the patient with walking, keep bed at its lowest position
and raise side rails. Lift immobilized patient carefully to minimize
bone stress.
Encourage the patient to drink plenty of water.

17. Drink at least six to eight glasses of water daily to lessen the
risk of kidney stones. Instruct the patient to avoid smoking.
Smoking may increase bone loss as well as increase risk of a
number of serious health problems.
Instruct the patient to avoid calcium- raising drugs
Certain medications, including some diuretics and lithium,
can raise calcium levels. Administer oestrogens to
postmenopausal women who are not able to undergo surgery.
Oestrogen may preserve bone mass and reduce calcium
levels.

18. Hypoparathyroidism is an uncommon condition in which
body secretes abnormally low levels of parathyroid hormone
(PTH). PTH is key to regulating and maintaining a balance
of body's levels of two minerals calcium and phosphorus.
The low production of PTH in hypoparathyroidism leads to
abnormally low calcium levels in blood and bones and to an
increase of phosphorus in blood.

19. Recent neck surgery, particularly if the thyroid was
involved
A family history of hypoparathyroidism
Having certain autoimmune or endocrine conditions,
such as Addison's disease — which causes adrenal
glands to produce too little of its hormones

20. Post-surgical hypoparathyroidism.
Autoimmune disease. Immune system creates antibodies
against the parathyroid tissues, trying to reject them as if
they were foreign bodies. In the process, the parathyroid
glands stop manufacturing their hormone.
Hereditary hypoparathyroidism.
Extensive cancer radiation treatment of face or neck.
Low levels of magnesium in blood.

21.  Tingling or burning (paraesthesia) in fingertips, toes and lips
 Muscle aches or cramps in legs, feet, abdomen or face
 Twitching or spasms of muscles, particularly around mouth, but also in your
hands, arms and throat
 Fatigue or weakness
 Painful menstruation
 Patchy hair loss
 Dry, coarse skin
 Brittle nails
 Depression or anxiety

22. History collection
Physical examination
Blood Tests
A low blood-calcium level, low parathyroid hormone
level, high blood-phosphorus level, low blood-
magnesium level
X-Ray

23.  Oral calcium carbonate tablets. Oral calcium supplements can increase calcium
levels in blood. However, at high doses, calcium supplements can cause
gastrointestinal side effects, such as constipation, in some people.
 Vitamin D. High doses of vitamin D, generally in the form of calcitriol, can help
body absorb calcium and eliminate phosphorus.
 Parathyroid hormone (Natpara). The Food and Drug Administration has approved
this once-daily injection for treatment of low blood calcium due to
hyperparathyroidism. Because of the potential risk of bone cancer
(osteosarcoma), at least in animal studies, this drug is available only through a
restricted program to people whose calcium levels can't be controlled with
calcium and vitamin D supplements and who understand the risks.

24. Diet
Rich in calcium. This includes dairy products, green leafy vegetables,
broccoli and foods with added calcium, such as some orange juice and
breakfast cereals.
Low in phosphorus. This means avoiding carbonated soft drinks,
which contain phosphorus in the form of phosphoric acid, and limiting
meats, hard cheeses and whole grains.
Intravenous infusion
Monitoring
Blood tests, because hypoparathyroidism is usually a long-lasting
(chronic) disorder, treatment generally is lifelong, as are regular
blood tests to determine whether calcium in particular is at normal
levels. doctor will adjust dose of supplemental calcium if blood-
calcium levels rise or fall.

25.  Reversible complications
 Tetany.
 Paraesthesia’s. These are characterized by
odd, tingling sensations or pins and needles
feelings in your lips, tongue, fingers and
toes.
 Loss of consciousness with
convulsions (grand mal seizures).
 Malformed teeth, affecting dental enamel
and roots.
 Impaired kidney function.
 Heart arrhythmias and fainting, even heart
failure.
 Irreversible complications
 Stunted growth (short stature)
 Slow mental development in children
 Calcium deposits in the brain, which can
cause balance problems and seizures
 Cataracts

26. There are no specific actions to prevent hypoparathyroidism.
If had surgery involving your thyroid or neck, watch for
signs and symptoms that could indicate hypoparathyroidism,
such as a tingling or burning sensation in your fingers, toes or
lips, or muscle twitching or cramping. If they occur, doctor
might recommend prompt treatment with calcium and
vitamin D to minimize the effects of the disorder.

27. Thyroxine[t4], triiodothyronine [t3], and calcitonin
are hormones produced by the thyroid gland that
affect metabolic rate, growth and development, and
serum calcium regulation. Hyperthyroidism is the
abnormally increased production of thyroid hormones
that may be treatment with anti-thyroid drugs,
surgery, or radiation therapy.

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