Indocyanine Green Angiography of Parathyroid Glands versus Intraoperative Parathyroid Hormone Assay as a Reliable Predictor for Post Thyroidectomy Transient Hypocalcemia

Abdelrahim, Hossam S; Amer, Ahmed F.; Nageeb, Ramy Mikhael

doi:10.1080/08941939.2022.2066229

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…A total of 1743 articles were screened (Figure 1) and 237 full‐text articles were assessed for eligibility. After careful selection of the articles, 66 studies were eligible for the final synthesis and were included in this review 10,14,23,24,27‐88 …”

Section: Resultsmentioning

confidence: 99%

“…Studies differed regarding the time to onset of weaning patients off supplementation. Among all studies with data, the median time to the first day of weaning off supplementation was 28 days (IQR, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. By meta-regression, the proportion of long-term hypoparathyroidism did not significantly change with increasing time to weaning off supplementation (0.002 change per day, 95% CI −0.001 to 0.004; P = .16, Supplemental 7A, available online).…”

Section: Long-term Hypoparathyroidismmentioning

confidence: 98%

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Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

van Dijk,

van Driel,

van Kinschot

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThe aim of this Meta‐analysis is to evaluate the impact of different treatment strategies for early postoperative hypoparathyroidism on hypocalcemia‐related complications and long‐term hypoparathyroidism.Data SourcesEmbase.com, MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched to September 20, 2022.Review MethodsArticles reporting on adult patients who underwent total thyroidectomy which specified a treatment strategy for postthyroidectomy hypoparathyroidism were included. Random effect models were applied to obtain pooled proportions and 95% confidence intervals. Primary outcome was the occurrence of major hypocalcemia‐related complications. Secondary outcome was long‐term hypoparathyroidism.ResultsSixty‐six studies comprising 67 treatment protocols and 51,096 patients were included in this Meta‐analysis. In 8 protocols (3806 patients), routine calcium and/or active vitamin D medication was given to all patients directly after thyroidectomy. In 49 protocols (44,012 patients), calcium and/or active vitamin D medication was only given to patients with biochemically proven postthyroidectomy hypoparathyroidism. In 10 protocols (3278 patients), calcium and/or active vitamin D supplementation was only initiated in case of clinical symptoms of hypocalcemia. No patient had a major complication due to postoperative hypocalcemia. The pooled proportion of long‐term hypoparathyroidism was 2.4% (95% confidence interval, 1.9‐3.0). There was no significant difference in the incidence of long‐term hypoparathyroidism between the 3 supplementation groups.ConclusionsAll treatment strategies for postoperative hypocalcemia prevent major complications of hypocalcemia. The early postoperative treatment protocol for postthyroidectomy hypoparathyroidism does not seem to influence recovery of parathyroid function in the long term.

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Section: Resultsmentioning

confidence: 99%

Section: Long-term Hypoparathyroidismmentioning

confidence: 98%

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

van Dijk,

van Driel,

van Kinschot

et al. 2023

Otolaryngol.--head neck surg.

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Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study

Devgan,

Mayilvaganan,

Mishra

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction: Indocyanine green (ICG) angiography is the ‘real-time intraoperative imaging’ technique used to reduce the chances of hypoparathyroidism in post-thyroidectomy patients. In our study, the authors predicted the risk of early post-thyroidectomy hypocalcemia by intraoperative evaluation of parathyroid gland perfusion by ICG angiography. Materials and methods: In patients who underwent total thyroidectomy, ICG angiography was done using the SPY PHI imaging system (Stryker). Post-thyroid specimen removal, scoring of parathyroids was done in spy contrast mode. All 4 or <4 visualized parathyroids were scored for vascularity with the highest score of 8. Serum ionized calcium was done 6 h postsurgery and on the morning and evening of postoperative days 1 and 2. Calcium supplements were given to only those who developed clinical or severe biochemical hypocalcemia. Results: Out of 60, postoperative hypocalcemia was noted in 41 patients. Total ICG score ≤5 was seen in 34 patients, out of which 28 developed postoperative hypocalcemia showing PPV 82.3% and diagnostic accuracy of 68.3% while iPTH (4.28 pmol/l) showed PPV 76.7 and diagnostic accuracy 70 %. In eight patients, none of the glands was scored as 2 (White) and all these patients developed hypocalcemia requiring calcium infusion. Conclusion: The absence of visualization of at least 1 well-perfused (score 2) gland on ICG angiography is highly predictive of hypocalcemia and the majority of patients with total ICG score ≤5 developed hypocalcemia in the immediate postoperative period. ICG is a good predictor of the absence of hypoparathyroidism after thyroidectomy and is comparable to iPTH in the prediction of post-thyroidectomy hypocalcemia.

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Indocyanine Green Angiography of Parathyroid Glands versus Intraoperative Parathyroid Hormone Assay as a Reliable Predictor for Post Thyroidectomy Transient Hypocalcemia

Cited by 2 publications

References 26 publications

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia‐Related Complications: A Meta‐Analysis

Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study

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