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

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