Objective:

To evaluate the efficacy of intra-operative autofluorescence imaging in reducing the unintentional excision rate of parathyroid glands during total thyroidectomy with central lymph node compartment dissection.

Approach:

• Study Design: A randomized prospective study involving patients with thyroid cancer undergoing total thyroidectomy with therapeutic bilateral central lymph node compartment dissection.
• Participants: Patients aged over 18 scheduled for non-emergency total thyroidectomy, excluding those with prior neck surgery, hyperparathyroidism, vitamin D deficiency, or certain medications.
• Intervention: Participants were randomly assigned to Group A (no autofluorescence) or Group B (with autofluorescence using FLUOBEAM® LX).
• Data Collection: Clinicopathological data were recorded, including the number of parathyroid glands identified and postoperative PTH and calcium levels.
• Statistical Analysis: Statistical tests were applied to compare groups, with a significance level set at p < 0.05.

Key Findings:

• A higher number of parathyroid glands were identified with autofluorescence compared to naked eye visualization (3.84 ± 0.51 vs. 3.69 ± 0.78, p = 0.03).
• The distinction between metastatic lymph nodes and parathyroid glands improved with autofluorescence.
• The number of parathyroid glands found in specimens was lower in Group B (17 vs. 8, p = 0.06), but this difference was not statistically significant.

Interpretation:

Limitations:

• The study did not report long-term outcomes related to hypoparathyroidism.
• The sample size may limit the generalizability of the findings.

Conclusion:

Intra-operative autofluorescence imaging may assist in identifying parathyroid glands during total thyroidectomy.