Research on Indocyanine Green Angiography for Predicting Postoperative Hypoparathyroidism

Hao Jin; Qichao Dong; Zhuocheng He; Jinrui Fan; Kun Liao; Min Cui


Clin Endocrinol. 2019;90(3):487-493. 

In This Article


For patients with thyroid diseases, the prevention of postoperative hypoparathyroidism is essential. Current methods evaluating parathyroid function is postoperative calcium and parathyroidism test. Compared to these methods, intraoperative ICG angiography can detect parathyroid in just a few minutes during the procedure of surgery. To avoid postoperative hypoparathyroidism, knowing the anatomical position of parathyroid glands is significant. ICG angiography provides a method for quick and valid evaluation of the parathyroid gland blood flow, which is a surrogate for parathyroid gland function.

Indocyanine green and the fluorescence imaging system are available in many medical centres. These features undoubtedly increase the usage of the parathyroid ICG angiography in the thyroid or the parathyroid surgeries. In modern times, ICG angiography is fundamental to complete a successful thyroidectomy surgery. The prevention of postoperative hypoparathyroidism has a pivotal role in the thyroid surgery patients. In many medical centres or hospitals, postoperative calcium or PTH supplementation plays a vital role in the metabolism of the postoperative thyroid surgery patients. The amount of PTH or calcium depends on the calcium level of the patient or patients' symptoms.[14]

The angiography imaging system is essential for a wide range of surgeries.[6] An initial objective of the study was to identify that ICG angiography has emerged as powerful platforms for predicting the function of the parathyroid immediately after thyroidectomy and at the same time, the fluorescence imaging system is fast becoming a key instrument in the thyroid and the parathyroid surgeries. The most obvious finding to emerge from the study is that ICG angiography can play an important role in addressing the issue of preventing intraoperative damage to parathyroid, protecting parathyroid vascularization and eventually preserving parathyroid glands. Another important finding was that ICG angiography is the most potential method known as allowing each parathyroid gland being evaluated separately with parathyroid function being evaluated at the same time. This study confirms that ICG angiography plays a crucial role in reimplanting parathyroid glands which is consistent with former evidences.[10] It can thus be suggested that ICG angiography has considerable impact on the ambulatory surgery. It can therefore be assumed that the ICG angiography has become a central issue for predicting and preventing post-thyroidectomy hypoparahtyroidism.

Research by Vidal Fortuny et al[11] found that ICG angiography in subtotal parathyroidectomy was a good technique for observing the parathyroid. This also is in accord with our observations. Study by Desmettre et al[12] showed a potential utility of ICG imaging of intraoperative localization of the parathyroid glands in neck surgery, which is consistent with our finding.

Data from several studies suggest that ICG administration may have some complications.[13] Recent work by researchers has established that some rare reactions like anaphylactic or urticarial reactions may occur.[15] During the past 34 years, only 17 adverse reactions has been reported and no more information has become available on the ICG dye allergic reactions.[15] What we know about ICG dye allergic reactions is largely based upon the fact that the ICG substance contains 5% of sodium iodine for solubility and the patients allergic to ICG were all iodine allergic and renal insufficient. But these reactions were reported to be 0.00167% and mostly occur in patients with history of allergy to iodides.[15] Accompanied with the anaesthesia team who are ready to treat allergic reactions, the ICG angiography possesses safety of a rather high degree.