Central neck dissection (CND) may have a negative effect on parathyroid glands (PGs) function. Indocyanine-green angiography (ICG) has shown that only one well-vascularized PG is enough to avoid postoperative hypocalcemia. Angiography-guided thyroidectomy (A-GT) was reported to significantly reduce postoperative hypocalcemia by preserving more well-vascularized PGs. We evaluated the effect of CND on postoperative hypocalcemia in patients undergoing A-GT.

Consecutive patients undergoing total thyroidectomy (TT) + CND from April 2016 to September 2023. A-GT was routinely performed since September 2020. In the Study group, ICG was initially injected to enhance the vascular map supplying PGs, then A-GT was performed. PGs perfusion was evaluated in every single PG after lobectomy+CND in all patients (control and study group) by using the 0-black, 1-gray, 2 white scoring system.

TT+CND was performed in 97/181 patients (71 bilateral CND, 26 unilateral) therefore 168 "sides" (lobectomies+CND) were included in the study: 97 "sides" (54 patients) in the control group and 71 sides (43 patients) in the study group. Superior PGs were significatively better preserved after A-GT, (p = 0.026) and CND didn't significatively reduce the quality of their perfusion (p = 0.510). A-GT patients showed a significant reduction of hypoparathyroidism episodes (p = 0.007) minimizing the deleterious effect of CND on inferior PGs function.

1.- A-GT preserved more well-perfused superior PGs reducing the number of hypocalcemic episodes significatively. 2.- After AG-T, CND didn´t have a deleterious effect on hypocalcemic episodes rate.