During parathyroidectomy for primary hyperparathyroidism, intraoperative PTH monitoring (Miami criterion) is used. The PTH level is measured at baseline and 10 minutes after excision of the presumed adenoma. Which result indicates a successful resection?

• A PTH drops by 30% from the pre-excision value
• B PTH drops to an absolute value below 65 pg/mL regardless of percentage decline
• C PTH drops by 50% from baseline regardless of the final absolute value
• D PTH drops by >50% from the highest pre-excision value AND falls into the normal range ✓

Explanation

The Miami criterion (the most widely validated intraoperative PTH criterion) defines cure as a >50% decline from the highest pre-incision or pre-excision PTH value (whichever is higher) AND a fall into the normal reference range (<65 pg/mL) at 10 minutes post-excision. Simply achieving a 50% drop without entering the normal range carries a higher false-cure rate, particularly in patients with multiglandular disease. This dual requirement has a cure-prediction sensitivity exceeding 97% and specificity of approximately 99%.

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.