Comparing PTeye-assisted Versus Conventional Total Thyroidectomy
Reducing Post-operative Hypoparathyroidism With Probe-based Near Infrared Autofluorescence (NIRAF)- Assisted Total Thyroidectomy Versus Conventional Total Thyroidectomy, a Randomized-controlled Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Post-operative hypoparathyroidism (PH) is a debilitating complication following total thyroidectomy. It arises from inadvertent removal or devascularization of the parathyroid glands. From a previous study in Hong Kong and other population-wide series, permanent PH rates could be as high as 11%, and transient PH rates being 30-48%, posing substantial burden on healthcare systems.
Near-infrared autofluorescence (NIRAF) technology has emerged to assist the identification and preservation of parathyroid glands during surgery. This study investigates the probe-based NIRAF device, PTeye™, which emits laser and receives NIR real-time, thereby detecting parathyroid glands by a simple touch of a probe.
A standardized protocol is devised to use PTeye™ for parathyroid identification at the early stage of surgery, in order to avoid devascularization or inadvertent removal of the parathyroids.
This is a prospective, single-blinded, randomized controlled trial to evaluate whether PTeye™ can reduce PH. The study will enroll consecutive patients undergoing total thyroidectomy in a tertiary endocrine surgery unit in Hong Kong. Patients will be randomized to receive conventional surgery or PTeye™-assisted surgery.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Man Him, Matrix Fung, MBBS
- Phone Number: +852 2255 4232
- Email: mmhfung@hku.hk
Study Locations
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-
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Hong Kong, Hong Kong
- Recruiting
- Queen Mary Hospital
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Contact:
- Man Him, Matrix Fung, MBBS
- Email: mmhfung@hku.hk
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adult patients ≥18 years of age
- Undergoing total thyroidectomy, or completion total thyroidectomy
- Pre-operative serum adjusted calcium levels within normal ranges
Exclusion Criteria:
- Patients on pre-operative calcium or vitamin D supplements
- Patients with pre-operative vitamin D deficiency, defined as serum vitamin D<30nmol/L
- Patients with untreated primary or secondary hyperparathyroidism
- Patient with known non-surgical hypoparathyroidism diseases
- Patients with estimated glomerular filtration rate <30ml/1.73m2/min, on dialysis, or having a history of kidney transplant
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Total thyroidectomy with the PTeye™ parathyroid detection system
PTeye™ assisted total thyroidectomy.
PTeye will be used to identify the parathyroid glands early in the course of surgery.
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The PTeye™ parathyroid detection system is an adjunctive tool to aid in the identification of visually suspected parathyroid tissue as granted by DEN17005.
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No Intervention: Conventional total thyroidectomy
Total thyroidectomy without PTeye™
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of significant post-operative hypoparathyroidism (SPH) after total thyroidectomy (in %)
Time Frame: 6 months
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Rate of significant post-operative hypoparathyroidism (SPH) after total thyroidectomy (in %)
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6 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of inadvertent parathyroidectomy (in %)
Time Frame: within 4 weeks from operation
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Rate of inadvertent parathyroidectomy (in %)
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within 4 weeks from operation
|
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Rate of parathyroid auto-transplantation (in %)
Time Frame: within operation
|
Rate of parathyroid auto-transplantation (in %)
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within operation
|
|
Day 0 PTH
Time Frame: Post-operative Day 0
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Day 0 Post-operative serum parathyroid hormone levels (pmol/L)
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Post-operative Day 0
|
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Day 1 Post-operative serum parathyroid hormone levels (pmol/L)
Time Frame: Post-operative Day 1
|
Day 1 Post-operative serum parathyroid hormone levels (pmol/L)
|
Post-operative Day 1
|
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3-month Post-operative serum parathyroid hormone levels (pmol/L)
Time Frame: Post-operative 3 months
|
3-month Post-operative serum parathyroid hormone levels (pmol/L)
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Post-operative 3 months
|
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6-month Post-operative serum parathyroid hormone levels (pmol/L)
Time Frame: Post-operative 6 months
|
6-month Post-operative serum parathyroid hormone levels
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Post-operative 6 months
|
Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- McWade MA, Sanders ME, Broome JT, Solorzano CC, Mahadevan-Jansen A. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery. 2016 Jan;159(1):193-202. doi: 10.1016/j.surg.2015.06.047. Epub 2015 Oct 9.
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014 Mar;101(4):307-20. doi: 10.1002/bjs.9384. Epub 2014 Jan 9.
- Benmiloud F, Godiris-Petit G, Gras R, Gillot JC, Turrin N, Penaranda G, Noullet S, Chereau N, Gaudart J, Chiche L, Rebaudet S. Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg. 2020 Feb 1;155(2):106-112. doi: 10.1001/jamasurg.2019.4613.
- Dip F, Falco J, Verna S, Prunello M, Loccisano M, Quadri P, White K, Rosenthal R. Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy. J Am Coll Surg. 2019 May;228(5):744-751. doi: 10.1016/j.jamcollsurg.2018.12.044. Epub 2019 Jan 31.
- Benmiloud F, Rebaudet S, Varoquaux A, Penaranda G, Bannier M, Denizot A. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery. 2018 Jan;163(1):23-30. doi: 10.1016/j.surg.2017.06.022. Epub 2017 Nov 6.
- Paras C, Keller M, White L, Phay J, Mahadevan-Jansen A. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt. 2011 Jun;16(6):067012. doi: 10.1117/1.3583571.
- Hospital Authority HK Surgical Outcomes Monitoring & Improvement Programme (SOMIP) Report 2022-2023. 15:
- Hospital Authority HK Surgical Outcomes Monitoring & Improvement Programme (SOMIP) Report 2021-2022. 14:
- Lui DTW, Fung MMH, Lee CH, Fong CHY, Woo YC, Lang BHH. A territory-wide assessment of the incidence of persistent hypoparathyroidism after elective thyroid surgery and its impact on new fracture risk over time. Surgery. 2021 Nov;170(5):1369-1375. doi: 10.1016/j.surg.2021.05.004. Epub 2021 Jun 8.
- Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973 Dec 15;4(5893):643-6. doi: 10.1136/bmj.4.5893.643.
- Solorzano CC, Thomas G, Baregamian N, Mahadevan-Jansen A. Detecting the Near Infrared Autofluorescence of the Human Parathyroid: Hype or Opportunity? Ann Surg. 2020 Dec;272(6):973-985. doi: 10.1097/SLA.0000000000003700.
- DiMarco A, Chotalia R, Bloxham R, McIntyre C, Tolley N, Palazzo FF. Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery? Ann R Coll Surg Engl. 2019 Sep;101(7):508-513. doi: 10.1308/rcsann.2019.0065. Epub 2019 Jul 15.
- Manatakis DK, Balalis D, Soulou VN, Korkolis DP, Plataniotis G, Gontikakis E. Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences. Int J Endocrinol. 2016;2016:7825305. doi: 10.1155/2016/7825305. Epub 2016 Aug 18.
- Luk Y, Fung MMH, Lui DTW, Liu X, Li L, Wong CKH, Lang BHH. Long-term kidney outcomes in patients with permanent hypoparathyroidism after total thyroidectomy for benign disease: A population-based study. Surgery. 2024 Sep;176(3):700-707. doi: 10.1016/j.surg.2024.05.005. Epub 2024 Jun 15.
- Ivanovic-Zuvic D, Chelebifski S, Uribe B, Quintana C, Dominguez JM, Olmos R, Florenzano P. Impaired Quality of Life in Patients with Post-Surgical Hypoparathyroidism. J Bone Metab. 2024 May;31(2):140-149. doi: 10.11005/jbm.2024.31.2.140. Epub 2024 May 31.
- Hillary SL, Chooi JE, Wadsley J, Newell-Price JD, Brown NJ, Balasubramanian SP. Quality of Life in Post-Surgical Hypoparathyroidism (PoSH) in Thyroid and Parathyroid Surgery. World J Surg. 2022 Dec;46(12):3025-3033. doi: 10.1007/s00268-022-06730-7. Epub 2022 Oct 2.
- Buttner M, Singer S, Taylor K. Quality of life in patients with hypoparathyroidism receiving standard treatment: an updated systematic review. Endocrine. 2024 Jul;85(1):80-90. doi: 10.1007/s12020-024-03807-2. Epub 2024 Apr 5.
- Pasieka JL, Wentworth K, Yeo CT, Cremers S, Dempster D, Fukumoto S, Goswami R, Houillier P, Levine MA, Pasternak JD, Perrier ND, Sitges-Serra A, Shoback DM. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res. 2022 Dec;37(12):2586-2601. doi: 10.1002/jbmr.4714. Epub 2022 Nov 23.
- Jorgensen CU, Homoe P, Dahl M, Hitz MF. Postoperative Chronic Hypoparathyroidism and Quality of Life After Total Thyroidectomy. JBMR Plus. 2021 Mar 16;5(4):e10479. doi: 10.1002/jbm4.10479. eCollection 2021 Apr.
- Frey S, Figueres L, Pattou F, Le Bras M, Caillard C, Mathonnet M, Hamy A, Brunaud L, Lifante JC, Tresallet C, Sebag F, Menegaux F, Blanchard C, Leroy M, Mirallie E; Qol-Hypopara Study Group. Impact of Permanent Post-thyroidectomy Hypoparathyroidism on Self-evaluation of Quality of Life and Voice: Results From the National QoL-Hypopara Study. Ann Surg. 2021 Nov 1;274(5):851-858. doi: 10.1097/SLA.0000000000005129.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- UW-25-412
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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