Preoperative localization of abnormal parathyroid tissue. Cumulative experience with venous sampling and arteriography

Selective venous catheterization has been utilized with radioimmunoassay for parathyroid hormone as a preoperative localization technic in 94 patients with primary hyperparathyroidism. Sampling from thyroid veins provided localizing data in 82 per cent of patients with adenoma and 74 per cent of patients with hyperplasia. Failures were due to inability to catheterize important draining thyroid veins. Large vein sampling was much less helpful, localizing disease in only 29 per cent of patients with adenoma and 13 per cent of patients with hyperplasia. Thyroid venous sampling was also successful in patients who had had previous neck surgery (72 per cent). In addition, this technic differentiated between adenoma and hyperplasia; 98 per cent of patients with unilateral gradients had adenoma; 85 per cent of patients with bilateral elevations had hyperplasia. Selective thyroid venous sampling was more reliable (78 per cent) than arteriography (39 per cent). Venous sampling alone would not be useful for diagnostic purposes because high concentrations of parathyroid hormone were also detected in the inferior thyroid veins of control populations. The results indicate that selective venous sampling and radioimmunoassay of parathyroid hormone are useful preoperative adjuncts to surgical exploration especially in patients who have had previous neck surgery.