Purpose: Frozen section (FS) is an established standard for decision-making during parathyroidectomy for primaryhyperparathyroidism (PHPT). While intraoperative parathyroid hormone monitoring (ioPTH) is used internationally, its adoption in Australasia is limited due to specialized equipment and assays. This study reports the first Australasian deployment of ioPTH using a standard parathyroid hormone (PTH) assay integrated into a hospital biochemistry service. Aim is to assess the efficacy and feasibility of ioPTH, vs FS, outline challenges in it’s implementation. Methods: A case-control study was conducted at Eastern Health on patients with PHPT (May 2022–Dec 2023), excluding redo parathyroid surgeries and suspected parathyroid carcinoma. Patients were divided into two groups: FS only and ioPTH+FS. Surgical success in the ioPTH+FS group was defined using the Miami criteria (>50% decline in PTH from pre-excision to 10 minutes post-excision). Outcomes assessed included surgical efficacy, result turnaround time, and correlation between FS and ioPTH findings. Results: 15 and 21 patients were recruited in FS and ioPTH+FS group respectively. The ioPTH+FS group had a higher proportion of minimally invasive parathyroidectomy (85% vs. 60%). Surgical cure rates were 85% in the ioPTH+FS group versus 65% in the FS group (p = 0.3). The mean time to results was 28 minutes for ioPTH+FS and 23 minutes for FS (p < 0.1). No complications were attributed to the ioPTH process. Conclusion: Our study highlights the feasibility and benefits of ioPTH using standard assays in Australasian hospital settings. The protocol enhances the success rate of parathyroidectomy and offers a practical alternative to FS, addressing barriers to adopting ioPTH in the current setting.