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% Document Info
\author{JanePorter (janeporter)}
\pdfinfo{
  /Title (parathyroid-gland-and-dysfunction.pdf)
  /Creator (Cheatography)
  /Author (JanePorter (janeporter))
  /Subject (Parathyroid Gland and Dysfunction Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Parathyroid Gland and Dysfunction Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{JanePorter (janeporter)} via \textcolor{DarkBackground}{\uline{cheatography.com/120660/cs/21937/}}}
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\noindent
\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}JanePorter (janeporter) \\
  \uline{cheatography.com/janeporter} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 4th March, 2020.\\
   Updated 4th March, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{{\bf{Anatomy}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{4 total} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Posterior aspect of thyroid gland} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Produce and release PTH} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{iCal determines level of PTH secretion in body indirectly. Decreased Ca\textasciicircum{}+\textasciicircum{} = increased PTH} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{PTH causes bone resorption, kidney absorption and GI absorption of Ca\textasciicircum{}+\textasciicircum{}} \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Prinicipal cells secrete PTH} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Half-life of PTH is 4-5 minutes} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Alkalosis = decreased Ca\textasciicircum{}+\textasciicircum{}} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Calcium}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{50\% bound to albumin} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{40-45\% free/ionized} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{5-10\% bound/unionized} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{ionized levels are regulated and affected by pH and temperature} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{low pH (acidotic) = increased ionized Ca\textasciicircum{}+\textasciicircum{}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{high pH (alkalosis) = decreased ionized Ca\textasciicircum{}+\textasciicircum{}} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Normal iCal = 4.4-5.4mg/dL} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Normal total calcium = 8.9-10.1mg/dL} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Small changes in iCal leads to large changes in PTH secretion}}} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{3.83229 cm} x{1.14471 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Hypercalcemia Lab Values and Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Normal serum Ca\textasciicircum{}+\textasciicircum{} levels = 8.9-10.1mg/dL} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Normal iCal = 4.75-5.7mg/dL; 1.19-1.33mmol/L} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Mild = \textless{}3mmol/L; 12mg/dL & \seqsplit{hydration} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
Moderate to severe = 3.2-3.7 mmol/L; 13-15 mg/dL & NS and lasix \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Other treatments}}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Ethacrynic acid - Na\textasciicircum{}+\textasciicircum{}/Ca\textasciicircum{}+\textasciicircum{} diuresis} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Biphosphonates - inhibit bone resorption} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Calcitonin - hormone to oppose PTH (decrease Ca\textasciicircum{}+\textasciicircum{})} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.96811 cm} x{1.78503 cm} x{0.82386 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Hypocalcemia}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Airway}} & {\bf{Neuromuscular \& CNS}} & {\bf{ECG}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Recurrent laryngeal nerve damage. Unilateral (hoarseness) Bilateral (stridor, obstruction) & Muscle cramps & \seqsplit{negative} \seqsplit{inotropy} \tn 
% Row Count 8 (+ 6)
% Row 2
\SetRowColor{LightBackground}
Bleeding - tracheal compression and edema & Chovstek's sign and Trousseau's Sign & \seqsplit{prolonged} QT \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
Hypocalcemic tetany - laryngospasm & Parasthesias &  \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Psychosis &  \tn 
% Row Count 14 (+ 1)
% Row 5
\SetRowColor{white}
 & Seizures &  \tn 
% Row Count 15 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{{\bf{Hyperparathyroidism}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{HYPERCALCEMIA}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Hypercalemia = \textgreater{}10.4 mg/dL} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Primary}} - most common - due to malignancy or parathyroid malfunction. 30-40 year olds. Single gland is usually benign - 80\% prevalence. {\bf{Secondary}} - 15\% - Hereditary and associated with MEN1 and MEN2A.} \tn 
% Row Count 7 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Signs and Symptoms:}} Renal - Ca\textasciicircum{}+\textasciicircum{} deposits with recurrent stones. Skeletal - pathologic fractures, skeletal demineralization. CNS - confusion, depression. Neuromuscular - weakness, fatigue. GI - nausea, vomiting, constipation, PUD, anorexia. Cardiac - prolonged PR, short QT, HTN and Osborne J waves.} \tn 
% Row Count 14 (+ 7)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Diagnosis:}} PTH assay with Ca\textasciicircum{}+\textasciicircum{} level. Will show increased levels of PTH and hypercalcemia.} \tn 
% Row Count 16 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Treatment:}} Mithramycin - inhibits osteoclasts, respiratory alkalosis, Calcitonin (stimulates osteoblasts; inhibits osteoclasts. i.e. Ca \textasciicircum{}+\textasciicircum{} is removed from the blood and used to build bone)} \tn 
% Row Count 20 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Most common cause of hypercalcemia is cancer. 25-50\% of the time it is breast cancer}}} \tn 
% Row Count 22 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Anesthetic Considerations:}} Pts will be sensitive to succinylcholine and antagonize non-depolarizing NMBs} \tn 
% Row Count 25 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Surgical considerations}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Arms will be tucked - IV access} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{NIM endotracheal tube to access nerve integrity} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Consider a deep extubation} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Intraop serum PTH. PTH levels should drop 20 minutes after removal} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Post-op hypocalcemia} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hypoparathyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{HYPOCALCEMIA, HYPOMAGNESEMIA and HYPERPHOSPHATEMIA}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Absence of deficiency of PTH secretion or resistance of peripheral tissues to PTH} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cause:}} Iatrogencic (i.e. inadvertent removal during thyroid surgery)} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Signs and Symptoms:}} neuronal irritability, muscle spasms, tetany, seizures, fatigue, stridor, apnea, CHF, hypotension, prolonged QT, decreased response to beta agonists, fatigue, Chvostek's sign, Trousseau's sign and mental status changes} \tn 
% Row Count 11 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Treatment:}} electrolyte replacement, avoid respiratory alkalosis (decreases Ca\textasciicircum{}+\textasciicircum{} further), phosphate binders (Sevalamir). {\emph{Severe hypocalcemia:}} 10-20 mL (90mg; 0.46mEq/L)  of 10\% Calcium Gluconate or 3-5 mL (270mg; 1.36 mEq) of Calcium Chloride followed by 1-2mg/kg/hr or Calcium infusion. {\emph{Calcium is incompatible with sodium bicarbonate}}} \tn 
% Row Count 18 (+ 7)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Anesthetic Management:}} be mindful that laryngospasm can occur, seizures, prolonged QT (zofran)} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}