No abstract

Purpose Postoperative hypoparathyroidism remains the most often complication in thyroid surgery. Near-infrared autofluorescence (NIR-AF) is a modality to identify parathyroid glands (PG) in vivo with high accuracy, but its use in daily routine surgery is unclear so far. In this randomized controlled trial, we evaluate the ability of NIR-AF to prevent postoperative hypoparathyroidism following total thyroidectomy. Methods Patients undergoing total thyroidectomy were allocated in two groups with the use of NIR-AF in the intervention group or according to standard practice in the control group. The aim was to identify the PGs in an early most stage of the operation to prevent their devascularization or removal. Parathyroid hormone was measured pre- and postoperatively and on postoperative day (POD) 1. Serum calcium was measured on POD 1 and 2. Possible symptoms and calcium/calcitriol supplement were recorded. Results A total of 60 patients were randomized, of whom 30 underwent NIR-AF-based PG identification. Hypoparathyroidism at skin closure occurred in 7 out of 30 patients using NIR-AF, respectively, in 14 out of 30 patients in the control group (p=0.058). There was no significant difference in serum calcium and parathyroid hormone levels between both groups. Likewise, NIR-AF could not detect PGs at a higher rate. Conclusion The use of NIR-AF may help surgeons identify and preserve PGs but did not significantly reduce the incidence of postoperative hypoparathyroidism in this trial. Larger case series have to clarify whether there is a benefit in routine thyroidectomy. Trial registration number DRKS00009242 (German Clinical Trial Register). Registration date: 03.09.2015

Parathyroidectomy was performed during a 5-year period in 11 of 196 patients undergoing maintenance dialysis for renal failure. Characteristics of the series were relatively long periods of dialysis, severe symptomatic bone disease, hypercalcemia, increased alkaline phosphatase, greatly raised serum levels of immunoreactive parathyroid hormone and X-ray changes appearing as abnormal bone structure, metastatic calcifications and pathologic fractures. Most of the operations consisted of total parathyroidectomy alone or accompanied by autotransplantation of parathyroid tissue. Subjective and objective improvement followed the operation in most cases, and the outlined indications thus appeared to be adequate. However, only a minority of the patients became symptom-free, and current methods of treating autonomic hyperparathyroidism in patients on regular dialysis must be regarded as suboptimal. The relative indications for the 2 types of operations are discussed. Total parathyroidectomy may be an acceptable operation for patients of this category.