Abstract Background Post-operative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. In the previous year’s autofluorescence (AF) detection and indocyanine green (ICG) injection were used to evaluate the parathyroid glands (PGs) during surgery, assessed to be useful to prevent HypoPTH. The aim of the study was to analyse the impact of AF and ICG to reduce the risk of HypoPTH. Methods A single-blinded randomized controlled trial with parallel assignment was conducted in a single Belgian tertiary referral centre. The use of AF with ICG injection was compared to the gold standard of visual identification of PGs. The primary outcome was the occurrence of HypoPTH six weeks after surgery. Results 50 patients were enrolled, 25 for each arm of the study. A total of 80 PGs were visualized in the AF and ICG group, compared to 76 in the control group (p=0.516). The prevalence of HypoPTH was not significantly different (32% in the AF and ICG group vs. 36%, p=0.765). Interesting, more patients in the AF and ICG group had lower levels of PTH (10 pg/mL) 4 hours after the surgery (28% vs. 12%) and developed early hypocalcaemia (12% vs. 8%, p=0.781). All patients recovered six-weeks after the surgery. Conclusions This study did not demonstrate a significant benefit of using AF with ICG to prevent transient HypoPTH. Even though more PGs were visualized in the AF and ICG group, the prevalence of HypoPTH and hypocalcaemia seems to be higher in this group, but the differences were not statistically significant.
Dughiero et al. (2026) studied this question.