ArticleBJS open2025
Investigating intraoperative parathyroid hormone criteria for enhanced accuracy and surgical success in treating primary hyperparathyroidism: results from two tertiary referral centres.
Article in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Can the outpatient parathormone value be used instead of the initial value in intraoperative parathormone measurement during primary hyperparathyroidism surgery?Updates in surgery · 2026Article
- Parathyroidectomy and the use of ioPTH. A survey of the United Italian Society of Endocrine Surgery (SIUEC).Updates in surgery · 2026Article
- Association of preoperative risk factors with therapeutic outcomes in primary hyperparathyroidism: A multivariate analysis of imaging and PTH-Calcium-Phosphate metabolic parameters in 164 cases.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025Article
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11 authors.
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Abstract
backgroundPrimary hyperparathyroidism is a common endocrine disorder necessitating surgical intervention for definitive treatment. Measurement of intraoperative parathyroid hormone (ioPTH) has revolutionized surgical management, but interpreting the results remains a subject of debate. This retrospective study, evaluated the efficacy of the Miami criterion (a > 50% decrease in ioPTH level 10 minutes after parathyroid removal) in predicting surgical success and whether meeting this criterion reduced persistence rates. It also investigated whether achieving a drop in ioPTH concentration to within the normal range, either alone or in combination with meeting the Miami criterion, led to improved outcomes.
methodsA retrospective analysis was conducted on patients with primary hyperparathyroidism who underwent surgery at two Italian tertiary referral centres. Univariate and multivariate analyses were used to identify predictors of persistence. The diagnostic performances of both ioPTH criteria were assessed, individually and in combination.
resultsData from 380 patients were analysed. Multivariate analysis confirmed the efficacy of both ioPTH criteria, showing a negative association between persistence and both a fall to within the normal range (P = 0.005) and a > 50% decrease in ioPTH level (P = 0.039). The > 50% reduction in ioPTH criterion demonstrated higher sensitivity (95.0%) and lower specificity (45.0%) than the normalization of ioPTH criterion (sensitivity 81.1% and specificity 60.0%). Combining the two criteria resulted in the highest sensitivity (97.5%) and an improved negative predictive value (55.0%) compared with each criterion alone, resulting in the highest accuracy.
conclusionA fall in ioPTH level to within the normal range helps prevent persistence, whereas a drop of > 50% reduces the rate of unnecessary bilateral neck explorations. Combining the two criteria yields the best results in terms of predicting surgical outcome.
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