Impact of Enhanced Parathyroid Autofluorescence on post-operative Hypoparathyroidism in thyroid cancer surgery

Background: Hypoparathyroidism (HypoPT) is one of the most common complications after thyroid surgery. In a recent meta-analysis by Edafe et al, the incidence of temporary and permanent hypoPT following thyroidectomy ranged from 19% to 38% and 0% to 3%, respectively. These rates are higher when surgery is offered for thyroid cancer when additional nodal dissection is performed. The visual identification of parathyroid gland is difficult because of its small size and appearance that is commonly confused with lymph node, fat or sometimes even thyroid tissue and to add to this is variability in its location. In 2011, Paras et al demonstrated parathyroid glands possess intrinsic autofluorescence (AF). By exploiting the inherent autofluorescence nature of parathyroid by use of Near infra-red imaging, the identification rates during surgery can be improved and by corollary, the incidence of hypocalcemia can be reduced post operatively. This study attempts to assess the Impact of Parathyroid Autofluorescence (both enhanced and non-enhanced) on parathyroid identification and in the incidence of post-operative hypoparathyroidism after thyroid cancer surgery.