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

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.