Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Purpose: The purpose of this single-blinded, 2-centre, randomized controlled trial was to test if near-infrared (NIR) autofluorescence image guidance for parathyroid gland (PG) detection during total thyroidectomy can reduce the incidence of hypoparathyroidism in both malignant and benign cases. Method: Patients admitted for primary or completion total thyroidectomy were randomized to either the NIR intervention group or the standard care NONIR (no near infrared) group. The primary endpoint was the rate of hypoparathyroidism at the 3-month follow-up, defined as hypocalcemia and inappropriately low parathyroid hormone levels and/or continuous treatment with active vitamin D. The secondary endpoint was the PG identification rate. Results: A total of 147 patients were included of whom 73 were allocated to NIR. Primary or completion thyroidectomy was conducted in 84 and 63 cases, respectively. A total of 130 completed 3 months follow-up. Postoperative hypoparathyroidism in the NIR group at 12 h, 1 month and 3 months was, respectively, 31.8, 14.1, 6.5% compared with 35.9, 18.9, 11.8% in the NONIR group (all p > 0.46). In the NIR group, the identification rate of PGs was 69.5% (146 of 210 PGs), and 9% (19 of 210 PGs) were identified only due to additional use of NIR. For 15 out of 69 patients (21.7%) additionally PGs was found. Conclusion: Hypoparathyroidism was nominally less frequent in the NIR group, although not statistically significant. Further studies are needed to confirm if NIR may be a supportive PG identification tool to minimize the number of PG which would have been otherwise missed, especially during more complicated thyroid procedures. Trial registry: ClinicalTrials.gov: NCT04193332. Registration date: 16.08.2019.

TidsskriftEuropean Archives of Oto-Rhino-Laryngology
Sider (fra-til)2593–2603
Antal sider11
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Ulla Feldt-Rasmussen’s research salary was supported by a grant from The Kirsten and Freddy Johansen’s Fund. The authors declare no financial or commercial conflict of interest.

Funding Information:
The authors acknowledge the Innovationsfonden, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital-Rigshospitalet and Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet and Department of Biomedical Sciences, University of Copenhagen, Denmark, for funding.

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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