Review of intraoperative parathormone monitoring with the miami criterion: A 25-year experience

Figure 1 Intraoperative parathormone monitoring dynamics demonstrating a > 50% drop when compared to the pre-incision parathormone level using the Miami criterion. A: The drop of pre-excision PTH level suggests that the surgeon identified the hyperfunctioning gland during dissection reflected in the drop of PTH level; B: During dissection, manipulation of the abnormal gland may result in a release of PTH into the bloodstream, reflected by a surge in PTH level. It is important in this scenario to observe a drop in the PTH level on the subsequent 5 and 10 min samples from the higher pre-excision PTH level. IPM: Intraoperative parathormone monitoring; PTH: Parathormone.

Figure 2 Intraoperative parathormone monitoring dynamics demonstrating > 50% drop using the Miami criterion when more than one abnormal parathyroid gland is removed. When the PTH level fails to drop > 50% from either pre-incision or pre-excision levels, there should be a suspicion for MGD. IPM: Intraoperative parathormone monitoring; MGD: Multiglandular disease; PTH: Parathormone.