Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy

Abstract

Primary hyperparathyroidism (pHPT) causes hypercalcemia. The treatment for pHPT is surgical dissection of the hyperfunctioning parathyroid gland. Lower rates of hypocalcemia and recurrent laryngeal nerve injury imply that minimally invasive parathyroidectomy (MIP) is safer than bilateral neck resection. Current trends in MIP use can be inferred only by reference to preoperative localization studies. Noninvasive imaging studies (typically preoperative localization studies) show good detection rates of hyperfunctioning glands; however, there have also been cases of nonlocalization or discordant results. Selective venous sampling (SVS) is an invasive localization method for detecting elevated intact parathyroid hormone in the thyroid and/or internal jugular and brachiocephalic veins. SVS was developed mainly for postoperative patients with persistent or recurrent pHPT; however, SVS could also be useful before initial operations due to its high sensitivity to pHPT. Currently, SVS is generally indicated for recurrent HPT, and for cases with negative imaging study results for HPT or discordant results. Multi-detector row helical CT is useful for imaging the anatomy of the jugular and thyroid veins. Knowledge of the thyroid vein anatomy enables the creation of sampling points in the internal jugular and brachiocephalic veins for catheterization of the thyroid veins and venous anastomoses.

Analysis of PTH serum concentration from internal jugular veins of patients with primary hyperparathyroidism

“…When the difference in concentration between the jugular PTH was greater than 20%, the side with the highest concentration was according to the location of the adenoma in 100% of the cases. We found no studies comparing PTH values of single-puncture jugular, only studies of selective jugular PTH collection through common femoral catheterization without comparing the concentration of the values, but with excellent results in the localization of adenomas 16 .…”

Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

“…оттока, в результате селективной катетеризации внутренних яремных, брахиоцефальных и/или вен щитовидной железы относительно периферических вен. По некоторым данным, чувствительность метода достигает 94%, а специфичность приближается к 100% [63,64]. На сегодняшний день в широкой практике не используется, учитывая риск осложнений и высокую информативность менее инвазивных методов диагностики.…”

Primer hiperparatiroidizmde preoperatif lokalizasyon çalişmalari

“…Bu yöntemin major dezavantajı patolojik lezyonun venöz örnek alınan yerin inferiorunda boyunun daha alt seviyesinde veya mediastende olmasıdır. [63] Bu yöntemin primer vakalarda katkısı sorgulanabilir. Bununla birlikte persistan veya reküren vakalarda daha komplike selektif venöz örnekleme gibi tekniklerden önce veya bu tekniklerin yapılamadığı durumlarda ek bir yöntem olarak akılda bulundurulabilir.…”