Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery.
Published: 6th February 2018
Authors: J. Vidal Fortuny, S. M. Sadowski, V. Belfontali, S. Guigard, A. Poncet, F. Ris et al.
Hypoparathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoparathyroidism, and obviate the need for systematic blood tests and oral calcium supplementation.
Between September 2014 and February 2016, patients who had at least one well perfused parathyroid gland on ICG angiography were randomized to receive standard follow‐up (measurement of calcium and parathyroid hormone (PTH) on postoperative day (POD) 1 and systematic supplementation with calcium and vitamin D; control group) or no supplementation and no blood test on POD 1 (intervention group). In all patients, calcium and PTH levels were measured 10–15 days after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10–15.
A total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoparathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non‐inferior to the control group (exact 95 per cent c.i. of the difference in proportion of patients with hypocalcaemia –0·053 to 0·053;
ICG angiography reliably predicts the vascularization of the parathyroid glands and obviates the need for postoperative measurement of calcium and PTH, and supplementation with calcium in patients with at least one well perfused parathyroid gland. Registration number: NCT02249780 (
You may also be interested in
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendicular and extra‐appendicular origin.
Authors: J.‐B. Delhorme, F. Severac, G. Averous, O. Glehen, G. Passot, N. Bakrin et al.
Notes: Survival similar
Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis. BJS 2018; 105: 270-278.
Authors: H. I. Kim, T. H. Kim, J.‐H. Choe, J.‐H. Kim, J. S. Kim, Y. N. Kim et al.
Notes: Volume is key
Effect of parathyroidectomy on quality of life and non‐specific symptoms in normocalcaemic primary hyperparathyroidism. BJS 2018; 105: 223-229.
Authors: S. Bannani, N. Christou, C. Guérin, A. Hamy, F. Sebag, M. Mathonnet et al.
Notes: Little improvement
Systematic review and simulation study of ignoring clustered data in surgical trials. BJS 2018; 105: 182-191.
Authors: S. Dell‐Kuster, R. A. Droeser, J. Schäfer, V. Gloy, H. Ewald, S. Schandelmaier et al.
Notes: A statistical lesson
Authors: J. Church
Authors: H. M. Rossitti, P. Söderkvist, O. Gimm
Notes: Genotype dictates type of surgery
Long‐term outcome of prophylactic thyroidectomy in children carrying RET germline mutations. BJS 2018; 105: e150-e157.
Authors: A. Machens, M. Elwerr, K. Lorenz, F. Weber, H. Dralle
Notes: Early surgery better
Authors: P. M. Ferguson, G. V. Long, R. A. Scolyer, J. F. Thompson
Notes: Great advances
Authors: S. Hill
Authors: M. A. Stammes, S. L. Bugby, T. Porta, K. Pierzchalski, T. Devling, C. Otto et al.
Notes: Visible results
Authors: D. C. Winter, M. Sund