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This study introduces the autofluorescence index, a quantitative measure of parathyroid gland heterogeneity using near-infrared autofluorescence, which can reliably distinguish pathologic from normal glands intraoperatively. An autofluorescence index threshold ≥2.5 strongly indicates a gland is hyperfunctional, assisting surgeons in challenging cases, especially differentiating single adenomas and multigland hyperplasia.
