April - June 2025, Volume 21, Issue 2

Boanta R, Misca M, Sabaru I, Grigorean V, Smarandache R, Strambu V, Brezean I

Value of the Indocyanine Green Fluorescence Score in Predicting Postoperative Hypoparathyroidism in Thyroid Surgery — A Prospective Observational Study

Acta Endo (Buc) 2025, 21 (2): 153-163
doi: 10.4183/aeb.2025.153

Context. Postoperative hypoparathyroidism is the most frequent complication of total thyroidectomy (transient form, 19-38%). Indocyanine green (ICG) fluorescence imaging is validated for parathyroid perfusion assessment; its predictive value combined with strict in situ preservation has not been reported in Romania. Objective. To evaluate the predictive performance of the Vidal Fortuny ICG score for transient postoperative hypoparathyroidism. Design. Prospective observational single-centre study (February 2024 - February 2025) at the National Institute of Endocrinology “C.I. Parhon”, Bucharest. Subjects and methods. Twenty-four consecutive adults received intraoperative ICG (5 mg IV; Karl Storz IMAGE1 S™ Rubina®) during thyroid surgery. Each parathyroid gland (PG) was assigned an ICG score (0/1/2) and a signal-to-background ratio versus the common carotid artery. Primary endpoint: biochemical hypoparathyroidism at 24 hours (PTH < 15 pg/mL or total Ca < 8.0 mg/dL). Results. Twenty-one women and 3 men; mean age 55.2 ± 14.1 years. All four PGs were identified in every patient (96/96, 100%). Score distribution (score 2/ 1/ 0): 63.5%/ 32.3%/ 4.2%. Transient hypoparathyroidism: 25.0%; dysphonia at 6 weeks: 0%. Sensitivity 66.7%, specificity 100%, PPV 100%, NPV 90%; LR– 0.33 (LR+ undefined: specificity 100%). Conclusions. As an adjunct to careful anatomical dissection, the ICG score reliably identifies devascularized parathyroid glands (specificity and PPV both 100%). In situ preservation without autotransplantation was safe. ICG complements anatomical dissection and warrants routine integration. Keywords: indocyanine green, thyroid surgery, postoperative hypoparathyroidism, near-infrared fluorescence, parathyroid preservation, perfusion score.

Keywords: indocyanine green, thyroid surgery, postoperative hypoparathyroidism, near-infrared fluorescence, parathyroid preservation, perfusion score.

Correspondence: Roxana Boanta MD, “C.I. Parhon” National Institute of Endocrinology - Bucharest 021918, Romania, E-mail: danaroxana.boanta@yahoo.com