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Further, we aimed to evaluate safety of ICG fluorescence and to correlate changes in PTH with postoperative hypoPT after TT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From May 2021 to June 2023, consecutive patients underwent TT and parathyroid fluorescence with ICG. Each visible parathyroid gland was scored 0, 1 or 2 depending on fluorescence intensity. Patients with at least one gland score of 2 were compared to those without. We measured PTH before and after TT, changes in calcium, creatinine and alanine transaminase (ALAT), postoperative alfacalcidol requirements, and adverse events of ICG use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 124 patients were included. Patients with at least one gland scored 2 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009108) had a reduced need for alfacalcidol at discharge compared with those without (8% vs. 38%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), although hypoPT was not fully excluded. Six patients required alfacalcidol after 12\u00a0months and were classified as having permanent hypoPT; all had an intraoperative PTH decrease\u2009&gt;\u200983%. Creatinine levels were higher in patients with permanent hypoPT compared to others (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). No increases in ALAT or ICG-related adverse events were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ICG-based parathyroid fluorescence during TT was well tolerated in this cohort and predicted immediate postoperative hypoPT. However, a fluorescence score of 2 did not exclude hypoPT development. The grading system is limited by subjectivity. No permanent hypoPT occurred in patients with a PTH decrease\u2009\u2264\u200983% after TT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-04149-5","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T15:19:52Z","timestamp":1785165592000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Indocyanine green fluorescence during total thyroidectomy: utility for predicting hypoparathyroidism and safety assessment"],"prefix":"10.1007","volume":"411","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-2714","authenticated-orcid":false,"given":"Rasmus","family":"Reinke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-6848","authenticated-orcid":false,"given":"Stefano","family":"Londero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0953-1188","authenticated-orcid":false,"given":"Martin","family":"Almquist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2152-4247","authenticated-orcid":false,"given":"Lars","family":"Rejnmark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0757-298X","authenticated-orcid":false,"given":"Lars","family":"Rolighed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"4149_CR1","unstructured":"Jorgensen CU, Homoe P, Dahl M, Hitz MF (2020) High incidence of chronic hypoparathyroidism secondary to total thyroidectomy. 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