Related Experiment Video
Updated: Aug 8, 2026
Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
Published on: August 17, 2022
Which intraoperative parathyroid hormone assay criterion best predicts operative success? A study of 352 consecutive
Bill Chiu1, Cord Sturgeon, Peter Angelos
1Section of Endocrine Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill 60611, USA.
Hypothesis:
The 6 published criteria for predicting curative parathyroid resection by means of intraoperative parathyroid hormone (IOPTH) assay are not equivalent.
Design:
Retrospective review of 352 patients undergoing parathyroidectomy for primary hyperparathyroidism from January 1, 1999, to December 31, 2004. We evaluated 6-month postoperative IOPTH values and serum calcium levels.
Setting:
Tertiary referral center.
Main Outcome Measures:
The IOPTH values at baseline (preincision and preexcision) and at 5 and 10 minutes after parathyroidectomy were reviewed according to the Miami criterion (>50% drop from highest baseline IOPTH level at 10 minutes after excision), criterion 1 (>50% drop from preincision IOPTH level at 10 minutes), criterion 2 (>50% drop from highest baseline IOPTH level at 10 minutes and final IOPTH level within the reference range), criterion 3 (>50% drop from highest baseline IOPTH level at 10 minutes and final IOPTH level less than the preincision value), criterion 4 (>50% drop from highest baseline IOPTH level at 5 minutes), and criterion 5 (>50% drop from preexcision IOPTH level at 10 minutes).
Results:
Criterion 2 had sensitivity of 88%, specificity of 22%, positive predictive value of 97%, and negative predictive value of 6%. Criterion 2 had good agreement with criteria 1 and 3. Of patients whose IOPTH level drop satisfied criterion 2 but not criterion 1, 14% had postoperative hypercalcemia at 6 months. When criterion 2 was not satisfied but criteria 1, 3, 4, and 5 and the Miami criterion were, failure rates were 0%, 4%, 7%, 6%, and 9%, respectively.
Conclusions:
Satisfying criterion 2 had a high operative success but resulted in additional unnecessary surgical exploration. Criterion 1 was better at predicting postoperative normocalcemia than criterion 2.
