Hypoparathyroidism and the consequent postoperative hypocalcaemia (POH) (<8,5 mg/dl) is the most frequent surgical complication in thyroid surgery. Near-infrared autofluorescence (NIRAF) utilizes the parathyroid (PG) ability to emit fluorescent light when exposed to light at 785 nm wave length. Our aim is to evaluate the potential reduction in POH after thyroid surgery with intraoperative use of NIRAF monitoring.

Between January 2018 and December 2022, 383 patients underwent thyroid surgery in our hospital. In 356 surgeries, PGs were traditionally identified, in 27 cases NIRAF was used. We used the IR EleVision device by Medtronic. We evaluated PG NIRAF response before and after thyroid resection, and once the surgical sample was extracted.

Over 96% of PGs were identified when NIRAF was utilized. With a statistical significance, POH was more frequent when NIRAF was not used, overall (163 vs 5) and in total thyroidectomies (151 vs 5) (p 0.0078). With a statistical significance, hospital stay was longer with POH (5.38±5.56 days VS 3.94±2.91 without). The calcemia and parathyroid hormone values in NIRAF group were higher than in the control group, with a statistically significant difference in calcemia at one month (9.46 ± 0.65 mg/dl vs 9.12 ± 0.54 mg/dl, p value 0 ,0019).

NIRAF appears to be a secure and beneficial technique, remarkably effective in reducing POH during thyroid surgery. Our study suggests that it has the potential to be standardized and implemented even in low-volume centres, leading to enhanced patient outcomes and reduced hospitalization costs overall.