A patient with primary hyperparathyroidism is found to have a single adenoma on sestamibi scan. Pre-operative PTH is 145 pg/mL. After surgical removal of the adenoma, intraoperative PTH measured at 10 minutes falls to 38 pg/mL. According to the Miami criterion, what should the surgeon do?
- A Explore remaining glands as cure is not confirmed
- B Conclude the operation as cure is confirmed ✓
- C Wait another 20 minutes for further PTH measurement
- D Send the resected adenoma for frozen section
Correct answer: B. Conclude the operation as cure is confirmed
Explanation
The Miami criterion for intraoperative PTH monitoring states that a drop of >50% from the highest pre-excision PTH value (either pre-incision or pre-excision value), combined with the PTH falling into the normal range, confirms adequate excision. Here, 145 pg/mL → 38 pg/mL represents a 73.8% drop, well exceeding the 50% threshold. A PTH of 38 pg/mL is within normal range. Both criteria are met, confirming successful excision of the hyperfunctioning parathyroid gland and allowing safe conclusion of the operation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.