Hyperparathyroidism vs Hypoparathyroidism: Calcium Up vs Calcium Down
PTH is the calcium thermostat — too much pulls calcium out of bones and floods the blood; too little leaves calcium trapped and muscles fire on their own. Mixing up these two on the NCLEX means you'll pick calcium gluconate for a patient who already has dangerously high calcium, or restrict calcium in someone seizing from hypocalcemia.
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Comparison
- ↑ PTH pulls Ca²⁺ from bone then hypercalcemia
- Primary: adenoma
- Secondary: CKD
- ↓/absent PTH then hypocalcemia
- #1 cause: damage/removal in thyroid surgery
- ★Bones, stones, groans, moans
- Muscle weakness, fatigue, hyporeflexia
- Polyuria, constipation
- ★Tetany
- + Trousseau & Chvostek signs
- Paresthesias, hyperreflexia
- Muscle cramps, laryngospasm
- ↑ Ca²⁺ (> 10.5), ↓ phosphorus
- ↑ PTH
- shortened QT
- ↓ Ca²⁺ (< 8.5), ↑ phosphorus
- ↓ PTH
- prolonged QT
- Hydrate with NS
- promote calciuresis
- Fall precautions
- strain urine
- telemetry
- Monitor airway for laryngospasm
- Seizure precautions
- keep IV calcium ready
- Bisphosphonates / calcitonin
- Loop diuretic only if volume-overloaded
- Parathyroidectomy / adenoma removal
- ★IV calcium gluconate (acute), slow push
- Oral calcium + vitamin D (chronic)
- Increase fluids
- stay mobile
- Avoid Ca²⁺/vit D supplements
- report stones
- Lifelong calcium + vitamin D
- High-Ca, low-phosphorus diet
- report tingling
- Bradycardia, heart block, arrest at very high Ca²⁺
- Potentiates digoxin toxicity
- ★Laryngospasm then airway emergency
- Tetany, seizures, prolonged-QT dysrhythmia
- Pathologic fractures
- kidney stones
- Cataracts
- basal ganglia calcification
Hyperparathyroidism (↑ PTH)
- ↑ PTH pulls Ca²⁺ from bone then hypercalcemia
- Primary: adenoma
- Secondary: CKD
Hypoparathyroidism (↓ PTH)
- ↓/absent PTH then hypocalcemia
- #1 cause: damage/removal in thyroid surgery
Hyperparathyroidism (↑ PTH)
- ★Bones, stones, groans, moans
- Muscle weakness, fatigue, hyporeflexia
- Polyuria, constipation
Hypoparathyroidism (↓ PTH)
- ★Tetany
- + Trousseau & Chvostek signs
- Paresthesias, hyperreflexia
- Muscle cramps, laryngospasm
Hyperparathyroidism (↑ PTH)
- ↑ Ca²⁺ (> 10.5), ↓ phosphorus
- ↑ PTH
- shortened QT
Hypoparathyroidism (↓ PTH)
- ↓ Ca²⁺ (< 8.5), ↑ phosphorus
- ↓ PTH
- prolonged QT
Hyperparathyroidism (↑ PTH)
- Hydrate with NS
- promote calciuresis
- Fall precautions
- strain urine
- telemetry
Hypoparathyroidism (↓ PTH)
- Monitor airway for laryngospasm
- Seizure precautions
- keep IV calcium ready
Hyperparathyroidism (↑ PTH)
- Bisphosphonates / calcitonin
- Loop diuretic only if volume-overloaded
- Parathyroidectomy / adenoma removal
Hypoparathyroidism (↓ PTH)
- ★IV calcium gluconate (acute), slow push
- Oral calcium + vitamin D (chronic)
Hyperparathyroidism (↑ PTH)
- Increase fluids
- stay mobile
- Avoid Ca²⁺/vit D supplements
- report stones
Hypoparathyroidism (↓ PTH)
- Lifelong calcium + vitamin D
- High-Ca, low-phosphorus diet
- report tingling
Hyperparathyroidism (↑ PTH)
- Bradycardia, heart block, arrest at very high Ca²⁺
- Potentiates digoxin toxicity
Hypoparathyroidism (↓ PTH)
- ★Laryngospasm then airway emergency
- Tetany, seizures, prolonged-QT dysrhythmia
Hyperparathyroidism (↑ PTH)
- Pathologic fractures
- kidney stones
Hypoparathyroidism (↓ PTH)
- Cataracts
- basal ganglia calcification
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High PTH = high calcium = bones break and stones form; low PTH = low calcium = muscles twitch and seize.
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