Can autofluorescence and ICG-angiography significantly reduce the rate of transient and definitive hypoparathyroidism after thyroid surgery? A propensity score matching analysis

Background Hypoparathyroidism is the most common complication following thyroid surgery. Near-infrared autofluorescence (NIRAF) and ICG-angiography (ICGa) have been adopted to enhance intraoperative localization and viability assessment of parathyroids. We compared transient (T-HypoPT) and permanent hypoparathyroidism (P-HypoPT) in patients undergoing bilateral thyroid resections with/without the use of NIRAF/ICG-a using a Propensity Score Matching (PSM) analysis. Methods We retrospectively reviewed all patients who underwent total thyroidectomy (TT) with/without central (CND) and lateral (LND) neck dissection performed in adult patients between January 2024 and November 2024. Patients were divided into two groups, NIRAF/ICGa-group and naked-eye (NE)-group, and matched (1:1) for age, sex, BMI, diagnosis and type of surgery with PSM analysis. Hypoparathyroidism (PTH<10pg/ml) was considered definitive if lasting >12 months after surgery. Subgroup analysis for LND if any and malignancy was performed. Results Out of 1460 patients included, 240 patients in the NIRAF/ICGa-group were matched with 240 in the NE-group. Rate of transient hypoparathyroidism was significantly lower in NIRAF-group: 38.3%vs51.7% (p=0.004). Rate of definitive hypoparathyroidism was lower in NIRAF-group although not significantly (2.92vs6.25%, p=0.127). In the TT-alone subgroup (all pathologic diagnoses), NIRAF-group showed a significantly lower rate of T-HypoPT (28.65%vs39.33, p=0.04), but not P-HypoPT (0.56%vs3.93%, p=0.067). In the malignant histology-subgroup analysis both T-HypoPT and P-HypoPT were significantly lower in NIRAF-group: 43.98%vs59.48% (p=0.026) and 0.86%vs7.76% (p=0.019), respectively. Conclusion NIRAF/ICG-a is able to significantly reduce the risk of T-HypoPT and maybe P-HypoPT hypoparathyroidism, especially in case of thyroidectomy for malignancy. Larger studies are needed to confirm these results and to evaluate the impact on LND.