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Published on: August 17, 2022
The influence of sample site on intraoperative PTH monitoring during parathyroidectomy
Derek T Woodrum1, Brian D Saunders, Barry G England
1Department of Surgery, University of Michigan, Taubman Center TC2920H, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0331, USA.
Insights
Intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy shows similar kinetics whether samples are drawn from peripheral veins or central veins. Central venous sampling may require a longer monitoring period for accurate interpretation.
Area of Science:
- Endocrinology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Intraoperative parathyroid hormone (IOPTH) monitoring is a standard practice during parathyroidectomy to confirm successful gland removal.
- The choice of blood sample site, peripheral vein (PV) versus central vein (CV), may influence the interpretation of IOPTH levels.
Purpose of the Study:
- To investigate whether the sample site (PV vs. CV) affects IOPTH measurements and interpretation during parathyroidectomy for single-gland disease.
- To compare the kinetics of IOPTH decay between peripheral and central venous sampling.
Main Methods:
- A prospective study of 201 patients undergoing curative parathyroidectomy for single-gland disease.
- IOPTH levels were measured from either PV (n=114) or CV (n=87) samples.
- Key metrics included baseline IOPTH, percentage decrease from baseline at 10 and 15 minutes, and IOPTH decay slope.
Main Results:
- Median baseline IOPTH was significantly higher in the CV group (268 pg/mL) compared to the PV group (191 pg/mL).
- IOPTH decay slopes and percentage decreases at 10 minutes were comparable between PV and CV groups.
- While CV IOPTH levels were higher at 10 minutes, the discrepancy resolved by 15 minutes, with similar percentages of patients achieving a >50% drop from baseline.
Conclusions:
- IOPTH kinetics demonstrate largely similar patterns regardless of whether samples are drawn from peripheral or central veins.
- Central venous sampling yields higher baseline IOPTH values and may require an extended monitoring duration (beyond 10 minutes) for accurate interpretation.
- Surgeons using central venous samples should consider extending the IOPTH monitoring period to ensure reliable assessment of parathyroid tissue removal.
Background:
Intraoperative parathyroid hormone (IOPTH) monitoring is common during parathyroidectomy. We hypothesized that sample site (peripheral vs central vein) may impact IOPTH interpretation.
Methods:
Two hundred and one patients underwent curative parathyroidectomy for single-gland disease. IOPTH was drawn peripherally (PV) in 114 patients and centrally (CV, jugular vein) in 87 patients. Decrease from baseline IOPTH and the presence of a normal value at 10 and 15 minutes were determined. The slope of IOPTH decay was calculated. These data were compared between sample sites.
Results:
Median baseline IOPTH was 268 pg/mL (CV) and 191 pg/mL (PV, P = .003). The mean IOPTH decay slopes were -0.75 (PV) and -0.76 (CV, P = NS), and the mean percent IOPTH decrease at 10 minutes was 79% PV and 80% CV (P = NS). At 10 minutes, a > or =50% drop from baseline was seen in 94% (CV) versus 97% (PV) of patients ( P = NS), resulting in a median IOPTH of 40 pg/mL (CV) versus 34 pg/mL (PV, P = .09). By 15 minutes, the central IOPTH had decreased by > or =50% of baseline in 98% of patients ( P = NS when compared to the 10-minute PV site).
Conclusions:
IOPTH kinetics are largely the same for PV and CV sample sites, but baseline values are higher with central sampling. Consequently, CV IOPTH levels are generally higher at 10 minutes, but this discrepancy resolves by 15 minutes. The surgeon utilizing CV samples may need to extend the sampling period.
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