The intraoperative measurement of parathyroid hormone is an established surgical adjunct that can be of help during parathyroidectomy in patients with SPHPT. This rapid assay has been shown to be effective in ensuring operative success with a limited operative approach that allows minimal dissection and selected gland excision. A specific protocol for defining hormone dynamics and a strict criterion for predicting operative success are necessary. With the method described in this chapter, the surgeon can excise only the hyperfunctioning parathyroid gland(s) without visualizing or disturbing the remaining normally functioning parathyroids. This surgical adjunct also redefines MGD. Instead of the traditional method of identifying abnormal glands based on size, weight, and/or histopathology, QPTH allows a precise recognition of gland hyperfunction based on hormone secretion during parathyroidectomy. The QPTH-guided parathyroidectomy is as successful as a bilateral neck exploration. Guided by hormone levels, parathyroidectomy has evolved into a highly successful and rapid operation, usually requiring minimal dissection, performed in an ambulatory setting.


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