title: The feasibility of indocyanine green fluorescence imaging for identifying and assessing the perfusion of parathyroid glands during total thyroidectomy.
abstract: BACKGROUND
  There are limited adjuncts available for identifying and assessing the viability of parathyroid glands (PGs) during total thyroidectomy (TT). The aim of this study is to determine the feasibility of indocyanine green (ICG) imaging in identifying and assessing perfusion of PGs during TT.
  
  
  METHODS
  ICG was administered in patients undergoing TT and fluorescence of PGs was assessed. A grading scale was developed for assessing degree of ICG uptake. Patients were evaluated for hypocalcemia and hypoparathyroidism on post-operative day (POD) #1.
  
  
  RESULTS
  Twenty-seven patients underwent TT with ICG imaging for multinodular goiter (n = 13), thyroid cancer (n = 10), and Graves' disease (n = 4). Eight-five PGs were identified visually, 71 (84%) of which showed ICG fluorescence. False negative rate was 6%. Post-operatively, three patients (11%) had a serum calcium value <8 mg/dl. ICG uptake after TT correlated with post-operative PTH levels: mean POD#1 PTH of those patients with at least two PGs exhibiting <30% fluorescence was 9 pg/ml; whereas those with fewer than two demonstrating <30% fluorescence had a POD#1 PTH of 19.5 pg/ml (P = 0.05).
  
  
  CONCLUSIONS
  ICG imaging of PGs during TT is feasible. ICG might be a useful adjunct in identifying those patients at risk for post-thyroidectomy hypoparathyroidism. J. Surg. Oncol. 2016;113:775-778. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nisar
authors.initials: N
authors.lastname: Zaidi
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Emre
authors.initials: E
authors.lastname: Bucak
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sarah
authors.initials: S
authors.lastname: Soundararajan
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alexis
authors.initials: A
authors.lastname: Okoh
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yigitbas
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Cem
authors.initials: C
authors.lastname: Dural
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007011:Hypoparathyroidism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007208:Indocyanine Green; D007430:Intraoperative Care; D008297:Male; D061848:Optical Imaging / Q000379:methods*; D010280:Parathyroid Glands / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: fluorescence; fluorescence-guided surgery; indocyanine green; near-infrared imaging; parathyroid; thyroidectomy