Related Experiment Video
Updated: Jan 11, 2026
Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
Published on: August 17, 2022
Parathyroid autofluorescence: A conditionally cost-effective tool to reduce postoperative hypocalcemia after total
Kirkpatrick B Fergus1, Patricia C Conroy2, Jessica Thiesmeyer3
1Department of Surgery, University of California, San Francisco, CA.
Background:
Postoperative hypocalcemia due to parathyroid removal/injury remains a major source of morbidity after thyroidectomy. Technologies using autofluorescence for parathyroid identification allow for parathyroid preservation. We aimed to determine if imaging-based autofluorescence was associated with decreased postoperative hypocalcemia and cost-effective.
Methods:
Randomized controlled trials examining patients undergoing total/completion thyroidectomy with versus without imaging-based autofluorescence were identified through a systematic review. Exclusion criteria included non-English language, total events <5, or missing 24-hour postoperative hypocalcemia and number of parathyroids on pathology. Meta-analysis was performed using inverse variance method for fixed and random effects models. For cost-effectiveness analysis, fixed upfront device plus recurring costs for the autofluorescence group were summed. Postoperative hypocalcemia rates were used as a proxy for effectiveness and overnight hospitalization likelihood.
Results:
Ten studies (2019-2024) with a pooled cohort of 1,878 patients (77% female, mean age 50 years) were included. Autofluorescence was associated with reduced inadvertent parathyroidectomy (odds ratio 0.42, 95% confidence interval 0.19-0.92) and postoperative hypocalcemia (odds ratio 0.59, 95% confidence interval 0.43-0.81). We calculated 17% of cases without and 11% with autofluorescence would have transient hypocalcemia. At high-volume centers (≥200 thyroidectomies/year), the incremental cost of device purchase at 1 year is +$36,458; at 10 years it saves -$382,413. In moderate-volume centers (≥50 thyroidectomies/year) the incremental costs were +$71,365 at 1 year and a savings of -$33,353 at 10 years.
Conclusions:
Imaging-based autofluorescence was associated with reduced risk of postoperative hypocalcemia after thyroidectomy and was conditionally cost-saving over extended device usage periods. Future studies examining the cost-effectiveness of other applications are warranted.
