During parathyroid exploration for primary hyperparathyroidism, intraoperative PTH (ioPTH) is measured. A 50% drop in PTH from the highest pre-excision level at 10 minutes post-excision is called:

• A Vienna criterion
• B Rome criterion
• C Tokyo criterion
• D Miami criterion ✓

Explanation

The Miami criterion for intraoperative PTH monitoring states that PTH must fall by more than 50% from the highest pre-incision or pre-excision level within 10 minutes of removing the hyperfunctioning gland. A drop meeting this criterion predicts cure in over 95% of cases, enabling focused parathyroidectomy without bilateral four-gland exploration. The Vienna criterion requires PTH to fall to the upper limit of normal or below; neither the Rome nor Tokyo criterion is a recognized designation in this context.

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

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Written and medically reviewed by the StethoPrep medical team.