HPT during pregnancy is under recognized and is associated with a 3.5-fold increase in miscarriage rates. Pregnancy loss often occurs in the second trimester and is associated with multiple miscarriages when not addressed. Pregnancy loss is more common as calcium levels exceed 11.4 mg/dl (2.85 mmol/l), but can be seen at all elevated calcium levels. Emphasis is placed on earlier recognition and surgical cure before becoming pregnant, however, once pregnant, surgery should be offered early in the second trimester for those with calcium levels above 11.4 mg/dl.

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FNA of parathyroid adenomas can cause a severe fibrotic process that typically involves adjacent tissues. This reaction dramatically increases the difficulty of surgical resection, often requiring microdissection techniques to preserve nerves and assure complete removal. The fibrosis can cause confusing histology mimicking malignancy. FNA of parathyroid adenomas should be avoided unless absolutely necessary.

Measures of sequestered radioactivity is an extremely accurate estimate of individual parathyroid gland hormone production allowing near 100% distinction between normal, hyperplasic, and adenomatous glands as well as distinguishing parathyroids from other neck tissues (fat, lymph nodes, thyroid). This instantaneous measurement is sufficient to determine which glands should be removed and which should remain in situ, while eliminating frozen sections and PTH assays in nearly all patients undergoing parathyroid surgery. This insight allows the operation to progress very rapidly.