The European Society of Endocrine Surgeons reviewed near-infrared autofluorescence imaging, with or without indocyanine green, for finding and checking parathyroid glands during thyroid surgery. The working group pooled 34 comparative studies of 9,322 patients, including 11 randomised trials, and agreed recommendations by Delphi vote.
The meta-analysis showed favourable results for immediate and permanent hypoparathyroidism, inadvertent parathyroid removal and autotransplantation. Evidence quality was rated moderate for most recommendations.
Where the equipment is available, this supports using autofluorescence as an aid in total thyroidectomy, particularly with central neck dissection, where parathyroids are most at risk. It is an adjunct to careful dissection, not a replacement for it. Access in India is limited to some tertiary centres, and cost will decide uptake.
- Consider near-infrared autofluorescence in total thyroidectomy where the equipment is available
- Prioritise it for central neck dissection and reoperative surgery, where gland injury is likeliest
- Keep meticulous capsular dissection as the foundation of parathyroid preservation
- Audit your hypoparathyroidism rates before and after introducing the technology
Why it matters
Permanent hypoparathyroidism is a lifelong burden, and imaging offers a way to reduce it beyond surgical experience alone.
Don't overread it
The abstract reports favourable pooled results without effect sizes; benefit depends on centre and surgeon experience.
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