A patient with primary hyperparathyroidism has a sestamibi scan showing a single left lower parathyroid adenoma. Intraoperative PTH monitoring is used. After removal, a 10-minute post-excision PTH level drops from 180 pg/mL to 38 pg/mL (>50% drop, within normal range). The appropriate next step is:

• A Explore all four glands to exclude multiglandular disease
• B Terminate the operation; criteria for cure met (Miami criterion) ✓
• C Wait 20 minutes and repeat PTH before deciding
• D Perform bilateral neck exploration regardless of intraoperative PTH

Explanation

The Miami criterion for intraoperative PTH monitoring requires a >50% drop from the highest preoperative/pre-excision level to a value within the normal range at 10 minutes post-excision, predicting cure with high accuracy (~97%). This criterion allows safe minimally invasive parathyroidectomy (MIP) guided by preoperative imaging, avoiding the morbidity of four-gland bilateral exploration in the majority of patients with solitary adenoma.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.