A 38-year-old man with hypercalcemia (Ca 11.8 mg/dL) and elevated PTH undergoes sestamibi scan showing a single hot focus inferior to the right thyroid lobe. Intraoperative PTH drops from 220 pg/mL to 160 pg/mL at 10 minutes after gland excision. What is the next step?
Answer: B
Explanation: A fall in PTH should be at least 50% from the highest baseline at 10–15 min (Miami criteria). Here, the drop is only ~27%. Waiting another 10 minutes is appropriate before deciding on exploration.
Teaching Points: Teaching point: Miami criteria require ?50% fall from peak PTH within 10–15 minutes.