ACTA ENDOCRINOLOGICA (BUC)

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.

Context. Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled. Case report. A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant’s demise at the age of 5 months. Conclusions. The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.