Bilateral internal jugular venous sampling for parathyroid hormone determination in patients with nonlocalizing...

Focused parathyroidectomy (FP) is offered to 60% to 70% of patients presenting to our unit with primary hyperparathyroidism (PHPT). A recent report identified bilateral internal jugular venous sampling (BIJVS) as a useful tool for localization of parathyroid adenomas in patients with scan-negative PHPT. The purpose of this study was to evaluate the utility of this approach in a clinical setting.

A prospective case-control trial was undertaken. Bilateral internal jugular venous blood samples were obtained. Patients were stratified into three groups: Group A consisted of patients with a negative sestamibi scan undergoing bilateral exploration; group B consisted of patients undergoing FP following a positive sestamibi scan; and group C patients were a control group undergoing total thyroidectomy.

In group A, 17 of 30 patients (56%) had lateralization of the parathyroid hormone (PTH) levels, with 11 correctly lateralizing to the side of the adenoma, 5 lateralizing despite bilateral disease, and 1 lateralizing to the contralateral side. Of the remaining 13 patients in whom there was no lateralization, 3 had bilateral multigland disease, and 10 had a single parathyroid adenoma. In group B, 17 of 30 patients (56%) also had lateralization of PTH levels, with 15 lateralizing to the side of the adenoma and 2 to the contralateral side. Lateralization failed in the remaining 13 patients, although in all of these patients the calcium and PTH levels normalized postoperatively. The control group of patients without parathyroid disease (group C) demonstrated lateralization of PTH levels in 23 of 30 patients (76%).

In our hands, BIJVS for PTH determination was not a useful adjunctive test facilitating FP. We continue to offer all patients with PHPT and a negative sestamibi scan a standard bilateral neck exploration.