Probe‐Based Near‐Infrared Autofluorescence for Parathyroid Identification During Thyroid Surgery: Clinical Outcomes, Surgeon Confidence, and Autofluorescence Thresholds

BACKGROUND: We evaluated experience with probe-based near-infrared autofluorescence (NIRAF) system (PTeye) in parathyroid gland (PTG) identification during total thyroidectomy. METHODS: In this retrospective study, patients undergoing total thyroidectomy using PTeye (2020-2022; n = 84) were compared with a historical visual-identification cohort (2018-2019; n = 103). RESULTS: PTG identification rates were comparable, although 42% of PTGs detected with PTeye were initially visualized with low or moderate confidence. Significantly fewer patients in the PTeye cohort had PTGs incidentally identified on histology (4.8% vs. 16.5%, p = 0.018), but there was no difference in the incidence of autotransplanted PTGs or total inadvertent parathyroidectomy. Postoperative calcium was higher with PTeye (median 9.2 vs. 9.0 mg/dL, p < 0.001). Postoperative PTH, transient, and permanent hypoparathyroidism did not differ. An autofluorescence ratio cutoff of 2.5 improved specificity compared with the manufacturer-recommended cutoff of 1.2. CONCLUSIONS: PTeye provides adjunctive confirmation of suspected parathyroid tissue, including glands initially identified with low or moderate visual confidence.