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Intraoperative Indocyanine Green Angiography of Parathyroid Glands and the Prevention of Post-Thyroidectomy Hypocalcemia

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Abstract

Background

We compared the reliability of indocyanine green (ICG) angiography and intraoperative PTH levels for predicting early post-thyroidectomy hypocalcemia.

Methods

Prospective study of 94 patients (71% women, mean age 53.7 years) undergoing total thyroidectomy. An ICG score of 2 (white) indicated a well-vascularized gland. PTH preoperative levels—PTH postresection levels divided by preoperative PTH × 100 was used to determine the PTH decline percentage. A decrease of at least 62.5% or <17.1 pg/mL in ioPTH was the criterion for predicting hypocalcemia.

Results

At surgery, the four parathyroid glands were identified in 50 (53.2%) patients and <4 glands in 44. Calcium supplements were needed by 22 patients (23.4%) postoperatively, 11 patients in each group of 4 and <4 parathyroid glands identified. The diagnostic accuracy of ICG angiography (0.883, 95% confidence interval [CI] 0.800–0.940) and ioPTH (0.862, 95% CI 0.775–0.92) was similar. When all four parathyroid glands were identified, ICG angiography showed a slightly higher diagnostic accuracy, specificity and positive predictive than ioPTH levels, but when < 4 glands were identified, the ioPTH showed a slightly higher diagnostic accuracy, specificity and positive predictive value. Differences were not statistically significant for any of the comparisons.

Conclusions

The presence of one well-perfused parathyroid gland (ICG score 2) using ICG angiography or ioPTH decline, measured before and after completion of thyroid surgery, is both reliable methods in prediction of early post-thyroidectomy hypocalcemia independently of the number of glands identified intraoperatively.

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Data availability

Data of the study are available from the corresponding author upon request.

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Acknowledgements

The authors thank Bernat Miguel Huguet, Ph.D., for statistical analysis and Marta Pulido, MD, for editing the manuscript and editorial assistance.

Funding

No funding was received for this clinical study.

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Authors and Affiliations

  1. Unidad de Cirugía Endocrina. Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), C/ Feixa Llarga s/n, 08907, Barcelona, Spain

    Pablo Moreno Llorente, Arantxa García Barrasa, José Manuel Francos Martínez, Marta Alberich Prats & Mireia Pascua Solé

Authors
  1. Pablo Moreno Llorente
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  2. Arantxa García Barrasa
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  3. José Manuel Francos Martínez
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  4. Marta Alberich Prats
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  5. Mireia Pascua Solé
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Contributions

P. Moreno Llorente was the principal investigator, designed the study, performer surgeries, interpreted data analysis, and wrote the manuscript; A. García Berrasa, J.M. Francos Martínez and M. Alberich Prats collected data and critically reviewed the manuscript. All authors have seen and approved the final draft.

Corresponding author

Correspondence to Pablo Moreno Llorente.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This study involves human participants and is in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Finally, this study was approved by the institutional review board of Hospital Universitari de Bellvitge, and all patients gave written informed consent.

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Moreno Llorente, P., García Barrasa, A., Francos Martínez, J.M. et al. Intraoperative Indocyanine Green Angiography of Parathyroid Glands and the Prevention of Post-Thyroidectomy Hypocalcemia. World J Surg 46, 121–127 (2022). https://doi.org/10.1007/s00268-021-06322-x

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  • DOI: https://doi.org/10.1007/s00268-021-06322-x

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