Question

In a patient operated for parathyroid adenoma, how do we confirm intraoperatively that the correct (culprit) gland has been removed?

• A. 50% reduction in PTH after 10 minutes
• B. 50% reduction in PTH after 5 minutes
• C. 25% reduction in PTH after 10 minutes
• D. 25% reduction in PTH after 5 minutes

Hint:

Recall the Miami criterion: how much PTH must fall, and at which minute mark?

Answer 1

The Correct Option is A

Remember it as the 'Miami 50 at 10' rule. PTH clears from blood in minutes, so once the surgeon plucks out the adenoma the hormone level should plummet. The Miami criterion declares cure when IOPTH falls by more than $50\%$ from the highest baseline value, checked $10$ minutes after excision. Map this onto the options: a $25\%$ drop is far too small a fall and could be reassured by a still-active second gland, so both $25\%$ choices are out. Between the two $50\%$ options, the classic Miami end point is sampled at $10$ minutes, not $5$. Hence a $50\%$ reduction in PTH at $10$ minutes is the confirmation of a successful, correctly targeted parathyroidectomy.