Split central venous sampling of parathyroid hormone: an adjunct to surgical exploration.

Abstract

Minimally invasive parathyroid surgery mandates preoperative localization of the adenoma for a targeted operative approach. This technique uses split internal jugular vein parathyroid hormone (PTH) samples to determine a gradient that then directs the surgical exploration. Blood samples were drawn low in the neck from the jugular veins after the neck was opened. The p values for the difference in PTH between the right and left internal jugular veins were calculated with independent sample t tests. For left-sided adenomas, the left internal jugular vein mean was significantly higher than the right p = .001). For right-sided adenomas, the right internal jugular vein mean was significantly higher than the left (p = .004). In hyperplasia, there was no significant difference (p = .43). This study demonstrates the usefulness of split PTH internal jugular vein samples in patients in whom preoperative localization failed. Eighty percent of these patients with a gradient were treated with site-directed unilateral exploration.