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The impact of near-infrared autofluorescence on postoperative hypoparathyroidism during total thyroidectomy: a case–control study

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Abstract

Purpose

Near-infrared autofluorescence is a new technology in thyroid surgery to better localize and preserve parathyroid glands. The purpose of this study is to assess if the adoption of NIR-AF can improve in short-, medium-, and long-term post-operative calcium and PTH levels compared to conventional “naked eye” surgery in patients undergoing TT for benign or malignant conditions.

Methods

134 patients undergone total thyroidectomy between January 2020 and June 2022; 67 were treated with conventional thyroidectomy, the other 67 underwent surgery adopting an autofluorescence detecting device.

Results

Significant differences were found between the two groups in percentage of patients with short-term hypocalcemia (p = 0.04) and short-term hypoparathyroidism (p = 0.011). Median short-term (p = 0.01) and medium-term (p = 0.03) PTH levels were significantly higher in autofluorescence group, while, short- (p = 0.001), medium- (p < 0.001) and long-term (p = 0.019) percentage variation of PTH levels from baseline were significantly higher in the standard-care group. Finally, the prescription of oral calcium (p < 0.01) after surgery were significantly lower in the autofluorescence group.

Conclusion

The adoption of near-infrared autofluorescence during total thyroidectomy is related to lower short-term hypocalcemia and hypoparathyroidism rates, decreased variation of post-operative PTH levels in short- and medium- and long-term, reducing the necessity of supplementation therapy with oral calcium compared to conventional surgery.

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Acknowledgements

The authors thank all the staff members of the department of Otolaryngology. The paper was published with written consents of all the patients involved.

Author contributions

D.B., P.I., E.S.: Drafted the article, made a substantial contribution to the concept or design of the work, made a substantial contribution to acquisition, analysis and interpretation of data. A.V., R.A.B., F.D.M., F.L.L., S.B.: made a substantial contribution to acquisition and interpretation of data. Revised the paper critically for important intellectual content. L.G., M.T., M.B.: made a substantial contribution to the concept or design of the work. Approved the version to be published.

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Author notes

  1. These authors contributed equally: Diego Barbieri, Pietro Indelicato

Authors and Affiliations

  1. Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Diego Barbieri, Pietro Indelicato, Emilio Salerno, Rosa Alessia Battista, Leone Giordano, Francesca Lira Luce, Matteo Trimarchi & Mario Bussi

  2. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy

    Pietro Indelicato, Emilio Salerno, Rosa Alessia Battista, Leone Giordano, Francesca Lira Luce, Matteo Trimarchi & Mario Bussi

  3. Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France

    Alessandro Vinciguerra

  4. Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Federico Di Marco

  5. Division of Head and Neck department, Otorhinolaryngology Unit, IRCCS Candiolo Cancer Institute, Torino, Italy

    Stefano Bondi

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  1. Diego Barbieri
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Correspondence to Diego Barbieri.

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The authors obtained approval from the Institutional Review Board (IRB) of San Raffaele Hospital for this study, which was conducted according to the ethical standards established in the 1975 Declaration of Helsinki, as revised in 1983.

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Barbieri, D., Indelicato, P., Vinciguerra, A. et al. The impact of near-infrared autofluorescence on postoperative hypoparathyroidism during total thyroidectomy: a case–control study. Endocrine 79, 392–399 (2023). https://doi.org/10.1007/s12020-022-03222-5

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