Jugular venous sampling of parathyroid hormone (PTH)

Differential jugular venous sampling has been used to lateralize the side of the neck harboring the most hyperfunctioning parathyroid gland(s) and thus avoid bilateral neck exploration. When performed intraoperatively, samples from both internal jugular veins, preferably guided by ultrasound, are taken before skin incision for rapid PTH measurement as shown here. This technique guides the surgeon to the side of the neck containing the highest PTH level. In this illustration, the PTH levels are higher on the right, which indicates that the disease is on the right side of the neck.