In primary hyperparathyroidism, the operative cure rate of minimally invasive parathyroidectomy (MIP) guided by preoperative Sestamibi scan is highest when which additional intraoperative tool confirms adequate resection?
- A Intraoperative ultrasound of the neck
- B Intraoperative parathyroid hormone (iPTH) assay — Miami criterion: >50% drop from highest pre-excision value at 10 minutes post-excision, falling into normal range ✓
- C Frozen section histology confirming parathyroid chief cell adenoma
- D Post-excision serum calcium level drawn immediately in theatre
Correct answer: B. Intraoperative parathyroid hormone (iPTH) assay — Miami criterion: >50% drop from highest pre-excision value at 10 minutes post-excision, falling into normal range
Explanation
The Miami criterion for intraoperative PTH monitoring requires the iPTH to fall by >50% from the highest pre-excision (either pre-incision or pre-excision) value AND fall into the normal range at 10 minutes after excision. This confirms removal of all hyperfunctioning tissue and predicts surgical cure with >95% accuracy. Frozen section cannot reliably distinguish adenoma from normal gland. Immediate post-excision calcium falls too slowly to be useful intraoperatively.
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.