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Войти в исследования Surgery · 2026
Near-infrared autofluorescence parathyroid imaging during total thyroidectomy to reduce the rate of postoperative hypoparathyroidism: A prospective two-center randomized clinical trial with a comprehensive long-term follow-up.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Andersen Amanda Oester, Christensen Anders, Lykke Eva, Straede Karina, Paaske Natasja, Feldt-Rasmussen Ulla, Klose Marianne Christina, Francisca Schrijvers Bieke Frieda, Hahn Christoffer Holst, Springborg Karoline Kanstrup, Stage Mads Georg, Hvilsom Gitte Bjørn, Jensen Lisbeth Birgitte, Hilsted Linda Maria, Dahl Morten, Kjaer Andreas, Homøe Preben, von Buchwald Christian
Аннотация
BACKGROUND: Postoperative hypoparathyroidism remains the most common complication after total thyroidectomy. Near-infrared autofluorescence leverages the intrinsic fluorescence of parathyroid glands, enabling intraoperative visualization and potentially improving gland preservation, thereby reducing postoperative hypoparathyroidism.
METHODS: A randomized clinical trial conducted at two Danish centers assigned total thyroidectomy patients to either the near-infrared autofluorescence or control group. Blood samples and data on hypoparathyroidism treatment were collected preoperatively, postoperative day 1, and at 1-, 3-, 9-, and 12-months follow-up. Hypoparathyroidism was defined by (1) the European Society of Endocrinology guideline definition, (2) ionized calcium <1.15, and (3) parathyroid hormone below the lower reference limit. Primary end points were hypoparathyroidism rates at 3 and 12 months; secondary end points included parathyroid gland identification rate, surgical duration, signal-to-background ratio, and parathyroid hormone/ionized calcium ratio.
RESULTS: A total of 189 patients were randomized (near-infrared autofluorescence: 93; control: 96). No significant difference in hypoparathyroidism rates was observed at 3 and 12 months (European Society of Endocrinology definition at 3 mo: near-infrared autofluorescence: 15.6%; control: 16.9%; P = .97). Subanalysis indicated greater near-infrared autofluorescence benefit during total thyroidectomy with central lymph node dissection. The parathyroid gland identification was significantly higher in the near-infrared autofluorescence group (3.1 vs 2.8; P = .045). The best-imaged parathyroid glands had a mean signal-to-background ratio_maximum of 2.3 and signal-to-background ratio_mean of 1.9. Near-infrared autofluorescence did not extend surgical duration or affect parathyroid hormone/ionized calcium ratios. A higher fraction of controls received calcium and vitamin D at 3 months (71.8% vs 59.0%; P = .16).
CONCLUSIONS: Despite improved parathyroid gland identification with near-infrared autofluorescence, there was no significant difference in rates of postoperative hypoparathyroidism at any follow-up.
METHODS: A randomized clinical trial conducted at two Danish centers assigned total thyroidectomy patients to either the near-infrared autofluorescence or control group. Blood samples and data on hypoparathyroidism treatment were collected preoperatively, postoperative day 1, and at 1-, 3-, 9-, and 12-months follow-up. Hypoparathyroidism was defined by (1) the European Society of Endocrinology guideline definition, (2) ionized calcium <1.15, and (3) parathyroid hormone below the lower reference limit. Primary end points were hypoparathyroidism rates at 3 and 12 months; secondary end points included parathyroid gland identification rate, surgical duration, signal-to-background ratio, and parathyroid hormone/ionized calcium ratio.
RESULTS: A total of 189 patients were randomized (near-infrared autofluorescence: 93; control: 96). No significant difference in hypoparathyroidism rates was observed at 3 and 12 months (European Society of Endocrinology definition at 3 mo: near-infrared autofluorescence: 15.6%; control: 16.9%; P = .97). Subanalysis indicated greater near-infrared autofluorescence benefit during total thyroidectomy with central lymph node dissection. The parathyroid gland identification was significantly higher in the near-infrared autofluorescence group (3.1 vs 2.8; P = .045). The best-imaged parathyroid glands had a mean signal-to-background ratio_maximum of 2.3 and signal-to-background ratio_mean of 1.9. Near-infrared autofluorescence did not extend surgical duration or affect parathyroid hormone/ionized calcium ratios. A higher fraction of controls received calcium and vitamin D at 3 months (71.8% vs 59.0%; P = .16).
CONCLUSIONS: Despite improved parathyroid gland identification with near-infrared autofluorescence, there was no significant difference in rates of postoperative hypoparathyroidism at any follow-up.