In primary hyperparathyroidism surgery, the Miami criterion for intraoperative PTH monitoring defines successful gland removal as what percentage drop in PTH from the highest pre-excision value at what time point?

• A Greater than 50% drop at 10 minutes post-excision ✓
• B Greater than 75% drop at 5 minutes post-excision
• C Greater than 50% drop at 5 minutes post-excision
• D Drop to within normal range at 20 minutes post-excision

Explanation

The Miami criterion requires a greater than 50% decrease in intraoperative PTH level measured at 10 minutes after excision of the suspected adenoma, compared to the highest pre-excision (baseline) value. This criterion has a sensitivity and specificity exceeding 95% for predicting operative cure. A drop at 5 minutes is sometimes used as a preliminary check, but the standard Miami criterion specifies the 10-minute time point.

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

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