Healthy parathyroid glands are crucial for calcium homeostasis. Identification and preservation of parathyroid glands during thyroid and parathyroid surgery pose significant challenges. The small size of these glands, their variable positioning, and their highly delicate and variable blood supply make them hard to distinguish from surrounding tissue and difficult to preserve with adequate perfusion. Inadvertent damage to or devascularization of parathyroid glands during surgery can lead to postoperative complications such as hypoparathyroidism and hypocalcemia, which can cause significant long-term health issues. Parathyroid glands exhibit a unique autofluorescence within the near-infrared spectrum, termed near-infrared autofluorescence (NIRAF). For neck endocrine surgery, the discovery of parathyroid NIRAF has been groundbreaking, paving the way for the development and clinical application of intraoperative methods that help surgeons identify and preserve parathyroid glands. Because NIRAF detection cannot be used to evaluate parathyroid gland viability and vascularity, other adjunct tools, such as contrast-enhanced angiography, can be used concurrently with NIRAF during neck endocrine surgery to assess parathyroid gland viability. This chapter will delve into different fluorescence-based tools, with a focus on existing NIRAF detection systems and contrast-enhanced angiography, for improved parathyroid gland identification and preservation.