In the event of recurrent hyperparathyroidism, it is generally easy to determine if the forearm graft is the cause based on parathyroid scanning, through selective venous sampling, or using a limb ischemia test which should result in substantial reduction of PTH after 15 min of ischemia if the forearm graft is indeed the cause of recurrent disease [7]. Here, PTH is linked to hyperparathyroidism.