Usefulness of ICG Angiography-Guided Thyroidectomy for Preserving Parathyroid Function

Area of Science:

• Endocrine Surgery
• Surgical Oncology
• Vascular Imaging

Background:

• Hypoparathyroidism is a frequent complication following total thyroidectomy, potentially leading to severe chronic illness.
• Preserving parathyroid gland (PG) function is crucial to prevent postoperative hypocalcemia.

Purpose of the Study:

• To assess the efficacy of indocyanine green (ICG) angiography-guided thyroidectomy in reducing postoperative hypocalcemia.
• To evaluate the impact of ICG angiography on parathyroid gland vascularization and preservation.

Main Methods:

• A prospective study comparing a historical control group (CG) with an angiography-guided thyroidectomy group (AG).
• ICG angiography was used post-surgery to predict immediate PG function and, in the AG, to visualize PG vascular supply.
• Postoperative and permanent hypocalcemia rates were compared between the two groups.

Main Results:

• The angiography-guided group (AG) showed significantly lower rates of postoperative hypocalcemia (5.6% vs. 26.2%) and permanent hypocalcemia (0% vs. 11.9%).
• A higher rate of well-vascularized PGs (score 2) was observed in the AG (52.9% vs. 39.2%).
• The odds ratio for permanent hypocalcemia was significantly reduced in the AG.

Conclusions:

• ICG angiography-guided thyroidectomy is an effective tool for identifying PG vascularization.
• This technique enables better PG preservation, leading to a significant reduction in hypocalcemia rates after total thyroidectomy.