Predictive Value of Intraoperative Parathyroid Hormone Levels via Central vs Peripheral Sampling

Intraoperative parathyroid hormone (ioPTH) predicts adequate resection during parathyroidectomy and can be sampled peripherally or via the internal jugular vein (IJ). Several criteria for ioPTH monitoring exist. This study compared the Miami and Rome criteria as well as IJ and peripheral sampling. This retrospective cohort study comprised parathyroidectomy patients from 2023 to 2025. We included 201 patients with primary hyperparathyroidism, of which 139 underwent IJ sampling and 62 underwent peripheral sampling. At 6 months, 186 (92.5%) patients were normocalcemic (131 in IJ subgroup vs 55 in peripheral subgroup). The proportions of cases meeting the criteria were 85.6% for Miami and 92.8% for Rome in the IJ subgroup, and 83.9% for Miami and 91.9% for Rome in the peripheral subgroup. Specificity was moderately higher in the IJ subgroup for Miami criterion (45.8% IJ vs 32.7% peripheral). While both sampling sites performed similarly across the criteria, Rome criteria exhibited superior diagnostic properties.