Analysis of central and peripheral PTH decay values in patients with primary hyperparathyroidism

TL;DR

This study compares PTH decay values from central and peripheral veins during parathyroid surgery to determine which is more reliable for monitoring tissue removal.

Contribution

The study provides evidence that central vein PTH measurements show greater decay and reliability during surgery compared to peripheral measurements.

Findings

Central vein PTH values showed a higher median decay (82.38%) compared to peripheral vein values (74.35%).

Initial PTH values were higher in the central vein but both sites approached homeostasis after surgery.

Central vein measurements are considered more reliable for intraoperative monitoring.

Abstract

•The minimally invasive parathyroidectomy is a procedure in which only the diseased parathyroid gland is removed.•PTH measurement collected from central jugular vein may allows the surgeon to quantitatively determine the excision of all hyperfunctioning parathyroid tissue more precisely.•Collections from peripheral and central sites were found to be effective in this study.•There is a tendency to use values collected from central sites, as they confirmed the ideal reduction in values following removal.

The minimally invasive parathyroidectomy is a procedure in which only the diseased parathyroid gland is removed.

PTH measurement collected from central jugular vein may allows the surgeon to quantitatively determine the excision of all hyperfunctioning parathyroid tissue more precisely.

Collections from peripheral and central sites were found to be effective in this study.

There is a tendency to use values collected from central sites, as they confirmed the ideal reduction in values following removal.

The aim of this study was to analyze the peculiarities of the collection sites.

It is a prospective study of patients undergoing parathyroidectomy by HPTP, with PTH values in the peripheral collection and from the ipsilateral VJI at times: initial (T0) and 10-min after removal of the diseased gland (T10).

61 participants were evaluated. The median PTH at baseline was 147.9 in the peripheral vein and 476.58 in the central vein. The median at T10 was 36 in the peripheral vein and 33 in the central vein. The central vein values showed a greater reduction, with the peripheral values showing a median decay of 74.35%, while the central values dropped by 82.38%. In the initial collection, PTH values were higher in the central vein, while they tended towards homeostasis after the removal of the diseased gland, regardless of the collection site. Thus, the average decay values from the central vein collections were higher and more significant than those from the peripheral veins.

The use of central values thus implies greater reliability for to intraoperative monitoring, with long-term comparative studies still being necessary to determine more targeted and effective surgical approaches.

Level III.