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

Financial support: None. Conflicts of interest: No conflicts of interest declared concerning the publication of this article. Submitted: July 2, 2021. Accepted: August 28, 2021. Study was carried out at the Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil. Congresso Brasileiro de Cirurgia de Cabeça e Pescoço 2021. Abstract Introduction: Parathyroidectomy is the only curative approach for primary hyperparathyroidism (HPTP). Several techniques are studied for a more targeted surgery. One of them consists of intraoperative PTH measurement (IO-PTH), which can be collected from a Peripheral Vein (PV) or from a Central Vein (CV), using the Internal Jugular Vein (VJI). Objective: The aim of this study was to analyze the peculiarities of the collection sites. Methods: 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 minutes after removal of the diseased gland (T10). Results: 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. Conclusion: 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.