NCLEX Memory Hints: Parathyroid Glands
Monday, February 24, 2025
Endocrine System: Parathyroid Glands
NCLEX Memory Hints © BrainyNurses.com
The parathyroid glands are found posteriorly to the thyroid gland and produce parathyroid hormone (PTH). In conjunction with calcitonin from the thyroid gland, they regulate the calcium level in the body. The release of PTH is stimulated by hypocalcemia and calcium is released from the bone. The release of calcitonin is stimulated by hypercalcemia. By blocking osteoclasts, calcitonin reduces the release of calcium from the bone into the bloodstream. The Memory Hint for this is “PTH pulls and calcitonin keeps.”
Because calcium, magnesium, and phosphorus levels are interrelated, any changes in function of the parathyroids affect all three values. Calcium and magnesium are generally parallel to each other and phosphorus is opposite. This applies to conditions where there is an increase or decrease in the levels but may not apply in certain disorders such as chronic renal failure.
Lab Relationships
• “Ca++, and Mg+ are parallel to each other.”
• “HPO4 is the opposite of Ca++ and Mg+ in the absence of some disorders.”
• A diet high is phosphorus leads to ↑ HPO4, ↓ Ca++, ↓ Mg+
• Hyperparathyroidism leads to ↑ Ca++, ↑ Mg+, ↓ HPO4.
• In renal failure, the relationship does not exist.
• Excretion of magnesium and phosphorus are impaired.
• Calcium reabsorption is impaired.
• Lab values ↑ Mg+, ↑ HPO4, ↓ Ca++.
Clinical Manifestations
The clinical manifestations of calcium, magnesium, and phosphorous are similar.
• Muscle twitching and seizure activity with ↓ Ca++, ↓ Mg+, and ↑ HPO4.
• Everything slows down (“nothing”) with ↑ Ca++, ↑ Mg+, and ↓ HPO4.
• Memory Hint: “Twitch, twitch, seize, seize” and then “Nothing”.
Chvostek’s and Trousseau’s are clinical assessments for muscle twitching.
Hypoparathyroidism
Hypoparathyroidism is a lifelong condition requiring calcium with vitamin D supplements and weight bearing to keep the calcium in the bone. There is a high risk for fractures and a walker may be recommended to prevent falls. Clinical manifestations include muscle twitching and seizure activity.
With the low calcium level, magnesium will also be low leading to an increased risk of a prolonged QT interval and the development of Torsades de pointes. Serum phosphorus will be high.
Hyperparathyroidism
Hyperparathyroidism may be caused by an enlargement of one or more of the glands and an overproduction of PTH. Surgery is the most common treatment with the enlargement and results in a cure. Secondary hyperparathyroidism may be caused by low calcium levels in other disease states such as chronic renal failure and after certain intestinal surgeries.
With the high calcium level, magnesium is often increased, and phosphorus is low. Everything slows down and leads to decreased reflexes, weakness, constipation, and a shortened QT interval and cardiac dysrhythmias.
General management includes weight bearing activities, increasing fluid intake to around 3,000 mL per day, and monitoring for renal calculi. Drug therapy includes analgesics for pain, diuretics, and calcitonin (Miacalcin) or bisphosphonates to keep calcium in the bone.
Memory Hints for The Parathyroid Glands
• PTH pulls and calcitonin keeps.
• Ca++, and Mg+ are parallel to each other.
• HPO4 is the opposite of Ca++ and Mg+ in the absence of some disorders.
• Twitch, twitch, seize, seize and then Nothing for manifestations.
Summary
In preparing for the NCLEX exam, knowledge of what parathyroid disorders will do to the serum calcium, magnesium, and phosphorus level is important. Complications can be significant with hypoparathyroidism including osteoporosis. And renal calculi potentially leading to post renal failure with hyperparathyroidism. Imbalances in calcium and magnesium can lead to cardiac dysrhythmias.
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