Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

J Vidal Fortuny, V Belfontali, S M Sadowski, W Karenovics, S Guigard, F Triponez, J Vidal Fortuny, V Belfontali, S M Sadowski, W Karenovics, S Guigard, F Triponez

Abstract

Background: Postoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery.

Methods: Angiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands.

Results: Some 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism.

Conclusion: PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism.

© 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

Figures

Figure 1
Figure 1
Representative parathyroid indocyanine green (ICG) angiography images. a A well vascularized parathyroid gland (ICG score 2). b A moderately well vascularized parathyroid gland (ICG score 1). c A devascularized parathyroid gland (ICG score 0). Circles and arrows indicate the parathyroid gland
Figure 2
Figure 2
Flow chart for the study of intraoperative parathyroid angiography with the fluorescent dye indocyanine green (ICG); an ICG score of 2 indicates a well vascularized parathyroid gland whereas a score of less than 2 indicates no perfectly well vascularized parathyroid gland (see text for details). Hypoparathyroidism was defined by a parathyroid hormone level below 1·1 pmol/l. POD, postoperative day

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