Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is guided by pre-operative localisation and intraoperative PTH assay. According to the Miami criterion for intraoperative PTH monitoring, the operation is considered a success when:
- A PTH falls >50% from the pre-excision baseline at 10 minutes post-excision ✓
- B PTH falls >50% from the highest pre-excision value at 10 minutes post-excision and falls into normal range
- C PTH falls to undetectable levels within 5 minutes of excision
- D Serum calcium normalises in the operating theatre
Correct answer: A. PTH falls >50% from the pre-excision baseline at 10 minutes post-excision
Explanation
The Miami criterion (the most widely used intraoperative PTH protocol) defines cure as a drop in PTH of >50% from the highest pre-excision value (baseline or pre-incision, whichever is higher) at 10 minutes after gland removal. It does NOT require the value to fall into the normal range — that is the Vienna criterion (which adds the requirement to fall within normal limits). The Miami criterion is the standard taught criterion for NEET PG. Serum calcium normalisation is too slow to be monitored 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.