{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T01:59:06Z","timestamp":1783562346269,"version":"3.55.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Primary 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 &amp;gt; 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data 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 &amp;gt; 50% decrease in ioPTH level (P = 0.039). The &amp;gt; 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A fall in ioPTH level to within the normal range helps prevent persistence, whereas a drop of &amp;gt; 50% reduces the rate of unnecessary bilateral neck explorations. Combining the two criteria yields the best results in terms of predicting surgical outcome.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf055","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T09:36:50Z","timestamp":1749807410000},"source":"Crossref","is-referenced-by-count":3,"title":["Investigating intraoperative parathyroid hormone criteria for enhanced accuracy and surgical success in treating primary hyperparathyroidism: results from two tertiary referral centres"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1943-4952","authenticated-orcid":false,"given":"Eleonora","family":"Lori","sequence":"first","affiliation":[{"name":"Department of Surgery, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"De Pasquale","sequence":"additional","affiliation":[{"name":"Thyroid and Parathyroid Surgery Service\u2013Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto M","family":"Saibene","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Castellani","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Pironi","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergaspare","family":"Palumbo","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Tripodi","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Forte","sequence":"additional","affiliation":[{"name":"Department of Urology, M. G. Vannini Hospital , Rome ,","place":["Italy"]},{"name":"Department of Sciences, Roma Tre University , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"De Vito","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1066-4671","authenticated-orcid":false,"given":"Gaetano","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Sorrenti","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u2018Sapienza\u2019 University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"2025061305364480700_zraf055-B1","doi-asserted-by":"crossref","first-page":"256","DOI":"10.5114\/reum\/170705","article-title":"Primary hyperparathyroidism: clinical manifestations, diagnosis and evaluation according to the fifth international workshop guidelines","volume":"61","author":"Kochman","year":"2023","journal-title":"Reumatologia"},{"key":"2025061305364480700_zraf055-B2","doi-asserted-by":"crossref","first-page":"2040284","DOI":"10.1155\/2021\/2040284","article-title":"Evaluation of Wisconsin and CaPTHUS indices usefulness for predicting monoglandular and multiglandular disease in patients with primary hyperparathyroidism through the analysis of a single-center experience","volume":"2021","author":"De Pasquale","year":"2021","journal-title":"Int J Endocrinol"},{"key":"2025061305364480700_zraf055-B3","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jamasurg.2016.2310","article-title":"The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism","volume":"151","author":"Wilhelm","year":"2016","journal-title":"JAMA Surg"},{"key":"2025061305364480700_zraf055-B4","first-page":"CD013035","article-title":"Parathyroidectomy for adults with primary hyperparathyroidism","author":"Pappachan","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"2025061305364480700_zraf055-B5","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1177\/000313480306901117","article-title":"Relapsing secondary hyperparathyroidism due to multiple nodular formations after total parathyroidectomy with autograft","volume":"69","author":"Falvo","year":"2003","journal-title":"Am Surg"},{"key":"2025061305364480700_zraf055-B6","first-page":"227","article-title":"Is extensive surgery really necessary in patients with parathyroid carcinoma? 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