A patient with primary hyperparathyroidism has a sestamibi scan showing a solitary adenoma in the right inferior position. She undergoes minimally invasive parathyroidectomy. Which intraoperative criterion confirms successful removal of the hyperfunctioning gland?

• A Serum calcium normalization within 1 hour of excision
• B Visual confirmation of a normal-colored gland opposite the adenoma
• C Frozen section showing chief cell hyperplasia
• D Intraoperative PTH drop by ≥50% from baseline at 10 minutes post-excision ✓

Explanation

The Miami criterion (or Wilson criterion) for successful minimally invasive parathyroidectomy requires that intraoperative PTH falls by ≥50% from the highest pre-incision or pre-excision value at 10 minutes after gland removal, and the absolute PTH value falls into the normal range. This rapid PTH assay has a half-life of ~3-5 minutes, so a ≥50% fall strongly predicts cure. Serum calcium does not normalize intraoperatively. Visual inspection is subjective. Frozen section is unreliable for parathyroid pathology.

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

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Written and medically reviewed by the StethoPrep medical team.