Clinical Report: Improved Identification and Preservation of Parathyroid Glands

Overview

This study evaluates the effectiveness of combining near-infrared autofluorescence (NIRAF) imaging with carbon nanoparticles (CN) in enhancing the identification and preservation of parathyroid glands during total thyroidectomy for papillary thyroid carcinoma. Results indicate that the NIRAF + CN group had a higher detection rate of parathyroid glands and improved early parathyroid activity compared to the CN group.

Background

Postoperative hypoparathyroidism is a common complication following total thyroidectomy, significantly impacting patient outcomes. Accurate identification and preservation of parathyroid glands during surgery are critical to minimizing this risk. Advanced techniques such as NIRAF and CN have been developed to improve intraoperative visualization of these glands.

Data Highlights

Key Findings

• The NIRAF + CN cohort detected a significantly greater number of parathyroid glands (91.9%) compared to the CN cohort (84.4%), p = 0.028.
• The rate of inadvertently removed parathyroid glands was lower in the NIRAF + CN cohort (5.0%) than in the CN cohort (15.0%), p = 0.263.
• The autotransplantation rate was higher in the NIRAF + CN cohort (20.0%) compared to the CN cohort (15.0%), p = 0.770.
• Serum PTH levels on the first postoperative day were significantly higher in the NIRAF + CN cohort (19.86 ± 11.15 pg/mL) than in the CN cohort (13.82 ± 9.13 pg/mL), p = 0.010.
• Transient hypoparathyroidism occurred in 25.0% of the NIRAF + CN cohort versus 37.5% in the CN cohort, p = 0.228.
• Permanently hypoparathyroidism was noted in 2.5% of the NIRAF + CN cohort compared to 7.5% of the CN cohort, p = 0.615.

Clinical Implications

The integration of NIRAF imaging with carbon nanoparticles may enhance the surgical identification and preservation of parathyroid glands.

Conclusion

The combined use of NIRAF and carbon nanoparticles improves intraoperative parathyroid gland preservation and early postoperative parathyroid function.

Related Resources & Content

1. Enhanced Visual Detection of Unintentionally Removed Parathyroid Glands Through Near Infrared Autofluorescence Imaging Guidance
2. Assessing the Impact of a Dual Dye Approach Using Indocyanine Green and Carbon Nanoparticles Combined with Parathyroid Hormone Testing on Parathyroid Gland Preservation During Surgery for Papillary Thyroid Cancer
3. Utilization of Autofluorescence Technology Enhances Parathyroid Function Preservation in Thyroid Surgical Procedures
4. Standardizing the reporting of postoperative hypoparathyroidism following thyroidectomy
5. Utilization of Near-Infrared Autofluorescence for Identifying Parathyroid Glands During Thyroid Surgery to Mitigate Hypoparathyroidism: A Prospective Randomized Study
6. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer
7. Standardizing the reporting of postoperative hypoparathyroidism following thyroidectomy: consensus statement from the European Society of Endocrine Surgeons, the American Association of Endocrine Surgeons, and the International Association of Endocrine Surgeons | BJS | Oxford Academic
8. Near-Infrared Autofluorescence for Parathyroid Detection During Endocrine Neck Surgery: A Randomized Clinical Trial | Endocrine Surgery | JAMA Surgery | JAMA Network
9. Camera-based near-infrared autofluorescence versus visual identification in total thyroidectomy for parathyroid function preservation: Systematic review and meta-analysis of randomized clinical trials - PubMed
10. Parathyroid autofluorescence: A conditionally cost-effective tool to reduce postoperative hypocalcemia after total thyroidectomy - ScienceDirect
11. The central lymph node dissection using carbon nanoparticle in transoral vestibular approach endoscopic thyroid surgery | Scientific Reports
12. https://www.nature.com/articles/s41598-024-76126-1.pdf
13. Frontiers | Enhanced Parathyroid Identification and Preservation in Total Thyroidectomy Using Combined Near-infrared Autofluorescence and Carbon Nanoparticles