A Single-center Audit of Post-thyroidectomy Hypoparathyroidism—Uncertain Ability of Near-infrared Autofluorescence Technology to be Cost-effective

indocyanine green.6 The ability of NIRAF to distinguish parathyroid from thyroid tissue was first described in 2011.7 Since that time, a number of studies have confirmed the ability of this technology IntroductIonThyroid surgery is the most common endocrine operation, with over 10,000 cases treated annually in the United Kingdom.The most common complication of bilateral thyroid surgery is postsurgical hypoparathyroidism (PoSH), which occurs when parathyroid glands (PGs) are damaged during surgery either through ischemic injury or inadvertent removal.The reported incidence of PoSH varies widely, from as low as 0.77% in high-volume centers 1 to as high as 60% in some reports. 2 Systematic follow-up of post-thyroidectomy patients in Sweden and Spain suggests the prevalence of PoSH to be closer to 8.7 3 and 14.5%, 4 respectively.This variation reflects differences in definitions, follow-up duration, and surgical expertise.UKRETS (United Kingdom Registry of Endocrine and Thyroid Surgery, an online registry maintained by members of the British Association of Endocrine and Thyroid Surgeons) demonstrated a volume outcome relationship for PoSH, with the lowest volume surgeons (<25 cases per year) having a lower incidence (6% per annum) than the intermediate volume (25-50 cases per year, 6.6%), declining to a minimum of 3% for the highest volume surgeons (>100 cases per year).5 In recent years, there has been increasing interest in using parathyroid autofluorescence to facilitate the correct intraoperative identification of PGs and to assess their vascularity based on