Evaluation of Parathyroid Gland Angiography with Indocyanine Green Fluorescence in Predicting Postoperative Parathyroid Gland Function in Patients Undergoing Total Thyroidectomy. | ||
| The Egyptian Journal of Surgery | ||
| Volume 44, Issue 3, July 2025, Pages 991-996 PDF (386.26 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2025.355031.1367 | ||
| Authors | ||
| Shaaban Mohamed Mohamed; Ramy Makhael Nagiub; Ibrahim Khaled Ibrahim; Karim Mohamed Ali* | ||
| Department of Endocrine Surgery Unit, Ain Shams University Hospitals, Cairo, Egypt | ||
| Abstract | ||
| Background: The most frequent side effect after thyroidectomy is still postoperative hypoparathyroidism. The goal of this pilot research was to evaluate the intraoperative parathyroid gland angiography’s ability to predict normal parathyroid gland function following thyroid surgery. Patients and Methods: Patients undergoing total thyroidectomy at Ain Shams University Hospitals – Endocrine Surgery Unit underwent intraoperative angiography using the fluorescent dye indocyanine green (ICG) to see the vascularization of the parathyroid glands that were detected. Results: ICG angiography was performed on 40 patients selected as follows: needs total thyroidectomy either due to benign or malignant causes. The study participants did not get prophylactic calcium supplementation. According to the ICG results, all individuals with at least one well-vascularized parathyroid gland had normal parathyroid hormone levels on postoperative day 1. Twenty-seven (67.5%) out of 40 patients in our research had an ICG score of less than or equal to 5, whereas 13(32.5%) out of 40 patients had an ICG score of higher than 5. In this study, 21(52.5%) out of 40 patients had hypocalcemia, whereas 19(47.5%) out of 40 patients did not experience any hypocalcemia following surgery. Ten out of 13 patients with an ICG score higher than 5 did not have postoperative hypocalcemia, while five out of 27 patients with an ICG score less than 5 did not develop any hypocalcemia postoperative. Conclusion: ICG-enhanced fluorescence imaging should be carefully evaluated before being used in endocrine surgery. This method is noninvasive, nonradiological, and safe. This technique, with a cutoff of fluorescence score 5, had a sensitivity of 77.8% while specificity was 73.9% with an accuracy of 0.760 in predicting postoperative hypocalcemia. | ||
| Keywords | ||
| Indocyanine green; Parathyroid hormone; Postoperative hypocalcemia; Total thyroidectomy | ||
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