Solving the unlocalized parathyroid: Experience with selective venous sampling in three patients
https://doi.org/10.15605/jafes.041.S1
- Author:
Yee Weai Cheong
1
;
Hwee Ching Tee
1
;
Ho Jin Hui
1
;
Shireen Siow Leng Lui
1
;
Aida Shazlin Binti Hamiddin
2
;
Siti Zubaidah Sharif
3
Author Information
1. Diabetes and Endocrine Unit, Department of Medicine, Hospital Queen Elizabeth II
2. Radiology Department, Hospital Queen Elizabeth
3. Breast and Endocrine Unit, Department of Surgery, Hospital Queen Elizabeth II
- Publication Type:Journal Article
- MeSH:
Humans
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):15-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Accurate preoperative localization is essential for the surgical management of primary hyperparathyroidism (PHPT).
Although ultrasound, technetium-99m sestamibi scintigraphy, and 4D-CT provide high localization rates, a subset of
patients have non-localizing or discordant imaging. Selective parathyroid venous sampling (PVS) is an invasive adjunct
that measures regional parathyroid hormone (PTH) gradients to aid localization in challenging cases. We present a threepatient case series demonstrating the utility of PVS in diagnostically complex PHPT.
Cases:We retrospectively reviewed three female patients (ages 44–63) with biochemically confirmed PHPT who underwent
selective PVS following negative or discordant imaging. Venous sampling was performed via femoral access with
catheterization of bilateral internal jugular, brachiocephalic, and bilateral thyroidal veins. PTH levels were measured at
each site and compared to peripheral levels to identify regional gradients. Surgical findings, intraoperative parathyroid
hormone monitoring (IOPTH), histopathology, and postoperative biochemical outcomes were recorded.
All patients had non-localizing or discordant preoperative imaging (USG, sestamibi, 4D-CT). PVS identified significant
PTH gradients, guiding focused parathyroidectomy. IOPTH monitoring confirmed successful excision in all operated
patients. Histopathology confirmed parathyroid adenoma in two cases; in the third case, the parathyroid tissue was
identified within the thyroid gland. Postoperative PTH levels suppressed (range 0.79–1.48 pg/mL) in keeping with
successful parathyroidectomy.
Conclusion:PVS effectively lateralized disease in imaging-negative PHPT and directly guided surgical management. When conventional
imaging fails, PVS combined with intraoperative PTH monitoring enables targeted surgery and favorable biochemical
outcomes.
- Full text:2026072810571581830BC_A003.pdf
