Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions
Authors' conclusion
In this cohort study of autofluorescence-guided thyroid surgery in low-volume, nonparathyroid institutions, the use of autofluorescence was associated with a significant decrease in both immediate and permanent hypoparathyroidism. When autofluorescence was used, hypoparathyroidism rates were comparable with those of high-volume surgeons who also perform parathyroid surgery.
Study context
- Population
- Adults referred for total thyroidectomy with no history of thyroid surgery, 2 low-volume nonparathyroid institutions in Denmarkall completed follow-up
- Participants
- 78 vs 89
- Exposure
- Autofluorescence-guided total thyroidectomy vs historical cohort
- Autofluorescencen = 78
- Historicaln = 89reference
- Outcome
- Rate of hypoparathyroidism: immediate (need for active vitamin D postoperatively) and permanent (still need for active vitamin D 1 year after surgery)
- Follow-up
- Postoperatively and 1 year
Methodological detailsmulticenter, historical control cohort, follow-up up to 1 year, Assessed 90; 89 without prior thyroid surgery; excluded lobectomy only (6) and declined (5)
- Multicenter
- Historical control cohort
- Follow-up up to 1 year
- Assessed 90; 89 without prior thyroid surgery; excluded lobectomy only (6) and declined (5)
Main finding
As reported in the abstract
Immediate hypoparathyroidism · postoperatively
P = 0.02
Observational data: associations, not effects.
Further findings
| Outcome | Autofluorescence | Historical | P value |
|---|---|---|---|
| Parathyroid glands identified | 75% (95% CI 70%–80%) | 61% (95% CI 56%–66%) | P < 0.001 |
| Parathyroid glands inadvertently excised | 4% (95% CI 1%–11%) | 21% (95% CI 13%–31%) | P = 0.001 |
- Permanent hypoparathyroidism (need for active vitamin D 1 year after surgery)
- P < 0.001
Permanent hypoparathyroidism (need for active vitamin D 1 year after surgery)
- Permanent hypoparathyroidism rates decreased, reaching 0% at the end of the study
Original publication
Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions. JAMA Netw Open. Published 1 May 2024. doi:10.
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