Abstract Background Permanent hypoparathyroidism (HypoPTH) remains a major complication of thyroid surgery. In a high-volume centre using standard techniques, we previously observed that HypoPTH was primarily driven by the surgical gesture, particularly central neck dissection (CND), rather than by oncological factors such as number of lymph nodes removed or nodal metastases, with the highest risk observed in ATA 2025 intermediate–high classes. Whether advanced optical technologies such as near-infrared autofluorescence (NIRAF) and indocyanine green (ICG) perfusion imaging modify this risk profile warrants investigation. Method We compared two high-volume cohorts: (1) 466 patients undergoing standard thyroidectomy (Centre A), and (2) 133 patients treated with NIRAF + ICG (Centre B). Outcomes included permanent and transient HypoPTH, postoperative PTH, ATA 2025 classes, lymph-node burden, and incidental parathyroidectomy. Analyses were repeated in the subgroup undergoing CND. Results In Centre A, permanent HypoPTH occurred in 8.8%, peaking at 22.8% in ATA intermediate–high classes. In Centre B, no cases of permanent HypoPTH occurred across any ATA class, indicating complete flattening of risk stratification. Transient HypoPTH in Centre B varied modestly by ATA (9.6–10.4% in low/intermediate vs 27.3% in high risk). Postoperative PTH levels were significantly higher in Centre B, even after adjusting for ATA class, CND, lymph nodes removed, and incidental parathyroidectomy. Among patients undergoing CND, Centre B maintained 0% permanent HypoPTH and significantly higher postoperative PTH. Conclusion Advanced optical technologies for parathyroid identification and perfusion profoundly reduce functional morbidity, mitigating the risk associated with CND and eliminating ATA-based stratification of permanent HypoPTH. These findings support the integration of NIRAF and ICG into precision endocrine surgery.
Melcarne et al. (2026) studied this question.