Intraoperative parathyroid hormone (ioPTH) monitoring during parathyroidectomy for primary hyperparathyroidism follows the 'Miami criterion'. A patient's pre-incision PTH is 180 pg/mL; 10 minutes after excision of the presumed adenoma, the PTH drops to 60 pg/mL. What is the correct interpretation and action?

• A Criterion not met — PTH should fall to below normal range
• B Criterion not met — must wait 20 minutes post-excision for valid measurement
• C Criterion met — PTH fell >50%; proceed to wound closure ✓
• D Criterion met only if PTH falls below 35 pg/mL (upper normal limit)

Explanation

The Miami criterion requires the intraoperative PTH to fall by >50% from the highest pre-excision value (either pre-incision or pre-excision), measured 10 minutes after gland removal. Here, PTH fell from 180 to 60 pg/mL — a 67% decline, which exceeds the 50% threshold. This predicts cure in >97% of cases. The criterion does NOT require PTH to fall within the normal range, which would be overly restrictive. Waiting 20 minutes is the alternative (Rome criterion), not universally required if the 10-minute criterion is met.

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

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Written and medically reviewed by the StethoPrep medical team.