Is bilateral jugular venous sampling a suitable strategy for primary hyperparathyroidism cases with parathyroid glands that cannot be localized with sestamibi?

Objective: Primary hyperparathyroidism (PHPT) is a common disorder. The surgical excision of all hyperfunctional parathyroid tissues is required to ensure long-term eucalcemia in these patients' curative treatment. This study aimed to evaluate whether parathormone (PTH) measurement via bilateral jugular venous sampling (BJVS) is an appropriate strategy for parathyroid adenoma lateralization in PHPT cases where parathyroid glands cannot be localized by imaging. Method: The study included 22 cases diagnosed with PHPT, which could not be localized by ultrasonography and technetium-99m sestamibi scintigraphy (99mTc-MIBI). The patients’ PTH levels were measured using BJVS, and unilateral neck exploration (UNE) was performed in those detected to have lateralization. Success rate, permanent or temporary recurrent laryngeal nerve (RLN) injury, and hypoparathyroidism were evaluated. Results: Parathyroid adenoma was successfully excised in 21 of 22 patients, and the success rate of PTH determination with BJVS was observed to be 94.5%. RLN injury and persistent hypoparathyroidism were not observed in any patient. Transient hypoparathyroidism was present in 9% of the patients. Conclusions: In PHPT cases where parathyroid glands cannot be localized on ultrasonography and 99mTc-MIBI, UNE can be safely performed after achieving PTH level lateralization with preoperative BJVS without the need for advanced imaging methods.