SAFE AND BENEFICIAL USE OF FLUORESCENCE DURING THYROIDECTOMY TO PREDICT HYPOPARATHYROIDISM.

AUTHORS:
R. Reinke (Aarhus, Denmark) , S. Londero (Aarhus, Denmark) , M. Almquist (Lund, Sweden) , L. Rejnmark (Aarhus, Denmark) , L. Rolighed (Aarhus, Denmark)
Background:
Parathyroid angiography with indocyanine green (ICG) might prevent and predict postoperative hypoparathyroidism (hypoPT) after total thyroidectomy (TT). We evaluated parathyroid gland vascularization with ICG during TT and correlated with postoperative hypoPT. Additionally, safety of using ICG was examined.
Methods:
Between May 2021 to June 2023 TT patients underwent parathyroid angiography with ICG and each visible parathyroid gland was scored 0, 1 or 2 depending on fluorescence intensity. We compared patients with at least one gland score of 2, to those without a single gland score of 2. We recorded creatinine and ALAT values, the need for alfacalcidol following surgery suggesting hypoPT, and any adverse events.
Results:
A total of 124 patients were included. Patients with a gland score of 2 had a reduced need for alfacalcidol at discharge (8% vs. 38%, p = 0.004) and after 2 months (6% vs. 25%, p = 0.036) compared to those without a gland scoring 2. No adverse events related to ICG were recorded. Creatinine increased from 66 µmol/L to 72 µmol/L (p = 0.001), with a higher increase in patients with hypoPT (13 µmol/L vs. 5 µmol/L, p = 0.008).
Conclusions:
Parathyroid angiography with ICG during TT significantly predicted the risk of immediate postoperative hypoPT. The identified creatinine increase after TT needs further evaluation. No adverse events were associated with the use of ICG. However, further research is needed to refine its quantitative assessment to reduce subjectivity in grading perfusion scores.