Abstract
The number of thyroid surgeries especially due to malignant indications has risen in past few decades in India as well as across the globe. The most common complication after Total Thyroidectomy is hypocalcemia from hypoparathyroidism which occurs majorly due to inadvertent removal of parathyroid glands or injury leading to devascularization of Parathyroid Glands. Post surgery hypocalcaemia is assessed by evaluating the value of post-surgery 24-48 hr Serum Calcium level. Majority of times the Post surgery hypocalcaemia is transient, it recovers in few weeks to months, only if it persists for > 6 months it is labelled as permanent hypocalcemia. According to literature incidence of transient and permanent Post surgery hypocalcaemia is 20–35 % and 1–10%, respectively. Post surgery hypocalcaemia can be symptomatic and morbid. It can only be prevented/decreased by early identification and preservation of Parathyroid Glands. The standard methodology is visual analysis of surgical field by operating surgeon. Parathyroid Glands are small in size, with colour similar to brown fat and their position in thyroid bed is also not consistent. They are difficult to identify and success in this method depends on the experience of operating team. This study evaluates the use of Near Infra- Red Imaging during thyroidectomy to preserve the Parathyroid Glands. Based on its inherent autofluorescence, when viewed through Near Infra-Red Imaging, at wavelength of 785 nm, there is a spontaneous and immediate emission of fluorescent light at 820–830 nm from Parathyroid Glands which is 2- to 11-fold enhanced signal over that of the surrounding tissue. The study consists of 7 patients who underwent Total or Completion Thyroid surgeries with use of Near-infrared imaging along with review of literature. None of the seven patients experienced Post surgery hypocalcaemia and in one patient Intrathyroidal Parathyroid Gland was identified with thyroid gland in-situ. The study advocates the use of Near-infrared imaging to make thyroid surgery safer.