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.
Comparison
- ↑ PTH pulls Ca²⁺ from bone → hypercalcemia
- Primary: adenoma; Secondary: CKD
- ↓/absent PTH → 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 → airway emergency
- Tetany, seizures, prolonged-QT dysrhythmia
- Pathologic fractures; kidney stones
- Cataracts; basal ganglia calcification
Hyperparathyroidism (↑ PTH)
- ↑ PTH pulls Ca²⁺ from bone → hypercalcemia
- Primary: adenoma; Secondary: CKD
Hypoparathyroidism (↓ PTH)
- ↓/absent PTH → 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 → airway emergency
- Tetany, seizures, prolonged-QT dysrhythmia
Hyperparathyroidism (↑ PTH)
- Pathologic fractures; kidney stones
Hypoparathyroidism (↓ PTH)
- Cataracts; basal ganglia calcification
★ marks the fact that sets a column apart.
Clinical Pearl
High PTH = high calcium = bones break and stones form; low PTH = low calcium = muscles twitch and seize.
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