Intraoperative prevention of postoperative hypoparathyroidism

Objective: More than 30,000 thyroid surgeries are performed annually in the Russian Federation. The surgeries are relatively safe because of the prevention methods for postoperative complications. Currently, there is no single effective method of postoperative hypoparathyroidism prevention. This complication is frequently reported and may be health and life-threatening.Aim: We aimed to estimate the effectiveness of the intraoperative ICG-angiography and intrathyroid injection of Brilliant Green for the prevention of postoperative hypoparathyroidism.Material and methods: One hundred and forty-three thyroidectomies were performed. Patients were divided into three groups: intraoperative angiography was used in 24 cases; Brilliant Green was injected in 58 cases to identify parathyroid glands; the visual estimation of the parathyroid preservation was used in 61 cases. Calcium level was measured in all patients before and after surgery.Results: Calcium level in the serum before and after surgery was 2.37 +/- 0.14 and2.27 +/- 0.17 in Group 1, 2.38 +/- 0.16 and 2.21 +/- 0.16 in Group 2, and 2.39 +/- 0.17 and2.18 +/- 0.19 in Group 3. Postoperative hypocalcemia was more prominent in thegroup with the visually estimated PTG than in the two other groups. Thedifferences in postoperative calcium levels in Groups 1 and 3 were statisticallydifferent. Pre- and postoperative Parathormone levels were 6.2 +/- 0.4 in Group 1,5.6 +/- 0.57 in Group 2, and 3.5 +/- 0.32 in Group 3. Postoperative levels significantlydiffered in Groups 1 and 3 (p<0.01) and in Groups 2 and 3 (p<0.05).Conclusions: ICG-angiography and intrathyroid injection of the Brilliant Green are safe methods of identification and sparing of the parathyroid glands. The severity of hypocalcemia and hypoparathormonemia in Group 3 shows the necessity of finding new methods in endocrine surgery to improve patient outcomes.

Automated summary

The study aimed to evaluate the effectiveness of ICG-angiography and intrathyroid injection of Brilliant Green in preventing postoperative hypoparathyroidism. The results showed that these methods are safe and effective in identifying and sparing the parathyroid glands, with a more prominent occurrence of hypocalcemia in the group with visually estimated PTG postoperatively.