Parathyroid identification by autofluorescence – preliminary report on five cases of surgery for primary hyperparathyroidism

[helvella]

Sounds a pretty good idea!

Case report

Open Access

Published: 28 August 2019

Parathyroid identification by autofluorescence – preliminary report on five cases of surgery for primary hyperparathyroidism

Abstract

Background

Intra-operative identification of parathyroid glands is often a challenge for surgeons performing parathyroid or thyroid surgery. Parathyroid glands stimulated by near-infrared light emit autofluorescence, which allows their discrimination from all other tissues in the region, and this may be of value during thyroid and parathyroid surgery. In this study, we present the results of the utilization of a low-cost device developed for the identification of parathyroid glands in surgery for primary hyperparathyroidism.

Case presentation

In 5 patients operated in our hospital with the diagnosis of primary hyperparathyroidism and non-concordant ultrasonography and Sestamibi scan, we used a 780 nm Light Emitting Diode (LED) to stimulate the cervical area. The resulting autofluorescence was visualized with night vision goggles with a 832 nm filter assembled.

In all the five patients, an easily distinguishable nodule was identified and excised, and confirmed as parathyroid adenoma by histological exam. Intra-operative PTH assay showed significant decrease compared with basal values, fulfilling the Miami Criteria for surgical success in use in our institution.

Conclusion

The utilization of autofluorescence for intra-operative identification of parathyroid glands may have a clinical application in surgery for primary hyperparathyroidism, being of special utility when ultrasonography and Sestamibi Scan are non concordant.

Open Access:

bmcsurg.biomedcentral.com/a...

I wonder if it could be exploited during thyroidectomy to help avoid damage to parathyroids?

[Hedgeree]

Hi helvella,

That was my initial thought.

When I had my partial thyroidectomy my first question for the surgeon afterwards was if I still had all my parathyroid glands.

If this would help the parathyroids to be more visible during thyroid surgery you would hope in turn that they would remain intact and avoid being damaged during thyroidectomy.

[helvella Administrator in reply to Hedgeree]

I keep wondering it they will ever be sensibly able to relocate one or more parathyroid glands as standard practice. It has been done...

Parathyroid Autotransplantation

endocrinepractice.org/artic...

[Regenallotment Ambassador]

is it just the parathyroid nodule that shows up or the parathyroid gland itself?

Just wondering if it is just for identifying parathyroid nodules 🤷🏽‍♀️

Smart idea, seems like a lot of damage occurs in thyroid surgery by the messages we see here. Potential game changer 🌱

[helvella Administrator in reply to Regenallotment]

As I read it, it is the parathyroid gland - not just a nodule/tumour on it.

[Regenallotment Ambassador in reply to helvella]

that sounds like a very useful discovery ⭐️