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ANATOMIC CONSIDERATIONS IN PARATHYROID VENOUS SAMPLING

PETER M. SHIMKIN M.D., JOHN L. DOPPMAN M.D., KENT D. PEARSON M.D., and DAVID POWELL M.R.C.P.

Forty-eight retrograde thyroid venograms were analyzed and correlated with parathyroid hormone (PTH) radioimmunoassay data.

The roentgenographic anatomy of the thyroid veins is presented. Also illustrated are 2 frequently confused veins, the anterior jugular and vertebral veins.

Parathyroid drainage occurs predominantly via the inferior thyroid vein. Although inferior thyroid drainage is variable, bilateral samples could be obtained in a high percentage of cases. The 3 most common patterns of inferior thyroid drainage permit bilateral sampling. Problems of inferior thyroid sampling included: ana tomic impediments such as valves; bypassing the discharge site of an adenoma; and choosing one of multiple veins draining a thyroid lobe. Probably least important for parathyroid drainage, the superior thyroid was the most constant and predictable of the thyroid veins.

Channels existed between the thyroid bed and the mediastinal veins other than the innominate veins in 22 cases. When the inferior thyroid veins drained primarily to the innominate veins, no collateral flow of hormone to other mediastinal veins could be detected in the 6 cases investigated. However, in 2 cases with cervical tumors, primary anomalous drainage of an inferior thyroid vein to the thymic system caused large hormone gradients in thymic samples.


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