Evaluation of Parathyroid Gland Angiography with Indocyanine Green Fluorescence in Predicting Postoperative Parathyroid Gland Function in Patients Undergoing Total Thyroidectomy.

Document Type : Original Article

Authors

Department of Endocrine Surgery Unit, Ain Shams University Hospitals, Cairo, Egypt

10.21608/ejsur.2025.355031.1367

Abstract

Background: The most frequent side effect after thyroidectomy is still postoperative hypoparathyroidism. The goal of
this pilot research was to evaluate the intraoperative parathyroid gland angiography’s ability to predict normal parathyroid gland function following thyroid surgery.
Patients and Methods: Patients undergoing total thyroidectomy at Ain Shams University Hospitals – Endocrine Surgery
Unit underwent intraoperative angiography using the fluorescent dye indocyanine green (ICG) to see the vascularization
of the parathyroid glands that were detected.
Results: ICG angiography was performed on 40 patients selected as follows: needs total thyroidectomy either due to
benign or malignant causes. The study participants did not get prophylactic calcium supplementation. According to the
ICG results, all individuals with at least one well-vascularized parathyroid gland had normal parathyroid hormone levels
on postoperative day 1. Twenty-seven (67.5%) out of 40 patients in our research had an ICG score of less than or equal to
5, whereas 13(32.5%) out of 40 patients had an ICG score of higher than 5. In this study, 21(52.5%) out of 40 patients had
hypocalcemia, whereas 19(47.5%) out of 40 patients did not experience any hypocalcemia following surgery. Ten out of
13 patients with an ICG score higher than 5 did not have postoperative hypocalcemia, while five out of 27 patients with
an ICG score less than 5 did not develop any hypocalcemia postoperative.
Conclusion: ICG-enhanced fluorescence imaging should be carefully evaluated before being used in endocrine surgery.
This method is noninvasive, nonradiological, and safe. This technique, with a cutoff of fluorescence score 5, had a
sensitivity of 77.8% while specificity was 73.9% with an accuracy of 0.760 in predicting postoperative hypocalcemia.

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