Parathyroid Hormone Sampling From the Anterior Jugular Vein Versus Peripheral Vein After Total Thyroidectomy

To determine if anterior jugular vein sampling (AJVS) is non-inferior to peripheral venous sampling (PVS) for measuring intraoperative parathyroid hormone (PTH) levels following total thyroidectomy.

This was a prospective non-inferiority trial conducted at a tertiary academic medical center. Adult patients undergoing total thyroidectomy for any indication at a tertiary care center were prospectively recruited. Intraoperatively, each patient received a peripheral intravenous line and anterior jugular veins were carefully isolated. After total thyroidectomy, baseline, 10-, and 20-min post-excision PVS and AJVS PTH levels were drawn simultaneously at each time point. Each patient served as his or her own control.

Fifty patients were recruited for the study. Of the 39 patients with intact and identifiable anterior jugular veins, AJVS was successfully performed in all patients (100%) at baseline, in 37 patients (95%) at 10-min post-excision, and in 35 patients (90%) at 20-min post-excision. There were five outliers in AJVS versus one outlier in PVS. Including outliers, AJVS was non-inferior to PVS in terms of mean intraoperative PTH level (AJVS vs. PVS, p value): baseline (169.5 pg/mL vs. 78.8 pg/mL, p < 0.01), 10-min post-excision (27.0 pg/mL vs. 24.8 pg/mL, p < 0.01), and 20-min post-excision (50.6 pg/mL vs. 47.8 pg/mL, p < 0.01). No postoperative complications were reported.

AJVS may be a safe and reliable non-inferior alternative to PVS for measuring intraoperative PTH levels during total thyroidectomy when present.