Postoperative and permanent hypocalcemia after indocyanine green (ICG) angiography-guided total thyroidectomy and central neck dissection: A retrospective cohort study.

Abstract

This study aimed to compare the rates of postoperative and permanent hypocalcemia between postthyroidectomy indocyanine green angiography and indocyanine green angiography-guided thyroidectomy performed intraoperatively for identification and preservation of the parathyroids. We undertook a retrospective study of 2 cohorts of patients with thyroid cancer undergoing total thyroidectomy and central neck dissection. The first cohort (control group) included patients who underwent postthyroidectomy indocyanine green angiography to predict parathyroid function by scoring the degree of fluorescence (0, black; nonvascularized; 1, gray/heterogeneous: partially vascularized; and 2, white: well vascularized), and the second cohort (angiography-guided thyroidectomy) included patients undergoing initially indocyanine green angiography-guided thyroidectomy to identify the feeding vessels of the parathyroid glands followed by postthyroidectomy indocyanine green angiography. There were 54 patients (97 sides) in the control group and 43 (71 sides) in the angiography-guided thyroidectomy group. The superior glands were significantly better preserved (indocyanine green score of 2) in the angiography-guided thyroidectomy group as compared with the control group (53.7% vs 34.5%, P = .026). The final parathyroids with an indocyanine green ICG score of 2 was greater in the angiography-guided thyroidectomy group than in the control group (47.8% vs 26.6%, P = .016). Postoperative hypocalcemia was significantly more common in the control group than in the angiography-guided thyroidectomy group (31.5% vs 7.0%, P = .007) as well as permanent hypocalcemia (11.1% vs 0%, P = .032). Indocyanine green angiography-guided thyroidectomy allowing identification of the vascular supply of the parathyroid glands contributes to preserve functioning glands and to prevent postsurgical hypocalcemia.