A 50-year-old man with a 2 cm solitary parathyroid adenoma confirmed on sestamibi SPECT-CT undergoes minimally invasive parathyroidectomy. Intraoperative PTH (ioPTH) is measured. Which criterion (Miami criterion) confirms adequate resection?

• A PTH drops more than 50% from the highest pre-excision value at 10 minutes post-excision ✓
• B PTH drops below 10 pg/mL within 10 minutes
• C PTH drops by at least 30% from baseline at 5 minutes post-excision
• D PTH normalises to within the normal reference range at any point during surgery

Explanation

The Miami criterion for ioPTH monitoring states that a drop of >50% from the highest pre-incision or pre-excision PTH level at 10 minutes after gland removal predicts cure with high sensitivity and specificity (approximately 98%). This criterion is the most widely used standard; the Vienna criterion additionally requires the post-excision value to fall within the normal range, which is more stringent. A drop to below 10 pg/mL is not a criterion, and a 30% drop at 5 minutes is insufficiently validated. The Miami criterion's strength lies in accounting for the short half-life of PTH (~3–5 minutes).

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.