Preserving parathyroid glands during thyroid surgery significantly impacts patients' well-being. Objective strategies to assess parathyroid gland perfusion remain limited, emphasizing the reliance on surgeon expertise. Intraoperative fluorescent imaging, particularly Indocyanine Green Angiography (ICGA), has emerged as a potential tool. This study evaluates ICGA's role in parathyroid preservation and predicting postoperative dysfunction.

This retrospective study included patients undergoing bilateral thyroidectomy between January 2021 and January 2023, excluding prior thyroidectomy, parathyroid disease, or chronic kidney disease. The cohort was comprised of a control group (n = 175) undergoing conventional surgery and an ICGA group (n = 120) utilizing ICGA during procedures. Propensity score matching was used to reduce selection bias during statistical analysis.

The ICGA group exhibited a significantly higher rate of parathyroid autotransplantation (p<0.01). Although not statistically significant, the control group showed a trend toward increased postoperative day 1 (POD1) hypoparathyroidism (p<0.09). Comparable rates of POD1 hypocalcemia and permanent hypocalcemia were observed. Subgroup analysis of patients undergoing central neck dissection revealed higher POD1 hypoparathyroidism in the control group (p<0.049).

A correlation between intraoperative ICGA use and increased autotransplantation rates as well as a trend for reduced incidence of postoperative hypoparathyroidism was demonstrated. Additionally, fluorescence intensity changes after a second ICG injection administration was shown, offering a promising strategy for surgeons to objectively evaluate parathyroid gland perfusion. Large cohort randomized control studies are required to further evaluate the impact of intraoperative ICGA use on parathyroid gland preservation.