Incidental parathyroidectomy is a common entity in patients underwent total thyroidectomy. The aim of this study is to determine the contribution of Indocyanine Green Angiography(ICGA) for prevention of this complication.

Patients underwent total thyroidectomy+/-central neck lymph node dissection between March and November 2023 were included in the study. Patients were divided to two groups according to the application of ICGA during surgery. ICGA applied before and after thyroidectomy to understand and evaluate the vascularization of parathyroid glands. Postoperative 6th, 24th hour and 1st month serum calcium, magnesium, phosphorus, alkaline phosphatase and parathormone(PTH) values, intraoperative findings as well as postoperative pathology reports were evaluated retrospectively.

A total of 106 patients were included to the study. ICGA were applied during total thyroidectomy in 23 patients(21.7%) and conventional total thyroidectomy(CTT) were performed in 83(78.3%) patients. Postoperative hypoparathyroidism(PTH<10pg/ml) at 6th hour were observed in 23(27.7%) patients in CTT group and 6(26.1%) patients in ICGA group(p=0.87). There were no difference between two groups for postoperative 6th, 24th hour and 1st month serum PTH values (21.1±14.3 vs. 23.3±16.8, 23.9±16.8 vs. 26.1±16.9, 39.8±20.4 vs. 39.7 ±21.9, p=0.69, p=0.54, p=0.75, respectively). In postoperative pathology results, incidental parathyroid tissue was observed in 30 patients (36.3%) in CTT (1 gland in 27 patients and 2 glands in 3 patients) and in ICGA group, an incidental parathyroid gland was observed in three patients (13%). In ICGA group significantly less parathyroid gland accidentally excised compared to CTT(p=0.042).

ICGA is helpful for parathyroid gland identification during total thyroidectomy and significantly decreases accidental parathyroidectomy.