{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T03:44:00Z","timestamp":1780371840046,"version":"3.54.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>More than 30,000 thyroid surgeries are performed annually in the Russian Federation. The surgeries are relatively safe because of the prevention methods for postoperative complications. Currently, there is no single effective method of postoperative hypoparathyroidism prevention. This complication is frequently reported and may be health and life-threatening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>We aimed to estimate the effectiveness of the intraoperative ICG-angiography and intrathyroid injection of Brilliant Green for the prevention of postoperative hypoparathyroidism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>One hundred and forty-three thyroidectomies were performed. Patients were divided into three groups: intraoperative angiography was used in 24 cases; Brilliant Green was injected in 58 cases to identify parathyroid glands; the visual estimation of the parathyroid preservation was used in 61 cases. Calcium level was measured in all patients before and after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Calcium level in the serum before and after surgery was 2.37\u00b10.14 and 2.27\u00b10.17 in Group 1, 2.38\u00b10.16 and 2.21\u00b10.16 in Group 2, and 2.39\u00b10.17 and 2.18\u00b10.19 in Group 3. Postoperative hypocalcemia was more prominent in the group with the visually estimated PTG than in the two other groups. The differences in postoperative calcium levels in Groups 1 and 3 were statistically different. Pre- and postoperative Parathormone levels were 6.2\u00b10.4 in Group 1, 5.6\u00b10.57 in Group 2, and 3.5\u00b10.32 in Group 3. Postoperative levels significantly differed in Groups 1 and 3 (p&amp;lt;0.01) and in Groups 2 and 3 (p&amp;lt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ICG-angiography and intrathyroid injection of the Brilliant Green are safe methods of identification and sparing of the parathyroid glands. The severity of hypocalcemia and hypoparathormonemia in Group 3 shows the necessity of finding new methods in endocrine surgery to improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1206881","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T16:16:49Z","timestamp":1699546609000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative prevention of postoperative hypoparathyroidism"],"prefix":"10.3389","volume":"14","author":[{"given":"Kristina","family":"Vabalayte","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anatoly","family":"Romanchishen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Somova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.14341\/ket20128220-30","article-title":"Predictors of postoperative hypoparathyroidism after thyroidectomy and methods of treatment","author":"Kuznetsov","year":"2012","journal-title":"Klinicheskaia i Eksperimentalnaia Tireoidologiia"},{"key":"B2","first-page":"88","article-title":"Postoperative hypoparathyroidism and a new way to prevent it","author":"Popov","year":"2010","journal-title":"Vestnik IuUrGU"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-014-3971-2","article-title":"Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs","volume":"29","author":"Suh","year":"2014","journal-title":"Surg Endoscopy"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-5330-y","article-title":"Intraoperative localization of the parathyroid glands with indocyanine green and Firefly(R) technology during BABA robotic thyroidectomy","volume":"31","author":"Yu","year":"2016","journal-title":"Surg Endoscopy"},{"key":"B5","first-page":"5","article-title":"Prophylactic thyroidectomy as method of medullary thyroid carcinoma prevention in children from MEN syndrome families","author":"Matveeva","year":"2017","journal-title":"Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"5\u221214","DOI":"10.17116\/hirurgia20211215","article-title":"Surgical care in the Russian Federation during the pandemic \u2014 the main results of 2020","author":"Revishvili","year":"2021","journal-title":"Pirogov Russian J Surg = Khirurgiya Zurnal im N.I Pirogova"},{"key":"B7","first-page":"5","article-title":"Possibilities and effectiveness of intraoperative recurrent laryngeal and accessory nerves monitoring during surgical interventions in patients with thyroid cancer\/\/VII Peterburgskii mezhdunarodnyi onkologicheskii forum \u201cBelye Nochi 2021\u201d. Tezisy foruma. Materialy VII Peterburgskogo mezhdunarodnogo onkologicheskogo foruma","volume":"148","author":"Vabalaite","year":"2021","journal-title":"Sankt-Peterburg"},{"key":"B8","article-title":"Topographic and anatomical justification of video-assisted access to the thyroid gland from the vestibule of the mouth","volume-title":"Molodezh v nauke: Novye argumenty: IV Mezhdunarodnyi molodezhnyi sbornik nauchnykh statei\/Otv. red","author":"Vabalaite","year":"2019"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.03.16","article-title":"Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences","volume":"3","author":"Anuwong","year":"2017","journal-title":"Gland Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2013.06.010","article-title":"Thyroidectomy: A novel endoscopic oral vestibular approach","volume":"1","author":"Wang","year":"2014","journal-title":"Surgery"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25451","article-title":"Feasibility of indocyanine green fluorescence imaging for intraoperative identification of parathyroid glands during thyroid surgery","volume":"41","author":"Van den Bos","year":"2019","journal-title":"Head Neck"},{"key":"B12","first-page":"647","volume-title":"Surgery of thyroid and parathyroid\/pod red. A.F. Romanchishen\u0430","author":"Romanchishen","year":"2009"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0309","article-title":"American thyroid association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults","volume":"28","author":"Orloff","year":"2018","journal-title":"Thyroid"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-019-02014-8","article-title":"Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis","volume":"66","author":"D\u00edez","year":"2019","journal-title":"Endocrine"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10101","article-title":"Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery","volume":"103","author":"Vidal Fortuny","year":"2016","journal-title":"Br J Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29297","article-title":"Autofluorescence and indocyanine green in thyroid surgery: A systematic review and meta-analysis","volume":"131","author":"Barbieri","year":"2021","journal-title":"Laryngoscope"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.09.14","article-title":"Hypocalcemia and permanent hypoparathyroidism after total\/bilateral thyroidectomy in the BAETS registry","volume":"6","author":"Chadwick","year":"2017","journal-title":"Gland Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-005-0032-y","article-title":"Incidental parathyroidectomy during thyroid surgery: an underappreciated complication of thyroidectomy","volume":"29","author":"Sakorafas","year":"2005","journal-title":"World J Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.21614\/chirurgia.114.5.602","article-title":"Postoperative hypoparathyroidism in patients after total thyroidectomy - experience of a tertiary center in Romania","volume":"114","author":"Martin","year":"2019","journal-title":"Chirurgia"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.06.13","article-title":"To identify or not to identify parathyroid glands during total thyroidectomy","volume":"6","author":"Chang","year":"2017","journal-title":"Gland Surg"},{"key":"B21","article-title":"Postoperative hypoparathyreosis, ways of prevention and correction","author":"Ayusheeva","year":"2013","journal-title":"Acta Biomed Sci"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.3.5776.680","article-title":"Methylene blue for rapid identification of the parathyroids","volume":"3","author":"Dudley","year":"1971","journal-title":"BMJ \u2116vol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-017-1641-2","article-title":"Use of methylene blue and near-infrared fluorescence in thyroid and parathyroid surgery","volume":"403","author":"Hillary","year":"2017","journal-title":"Langenbeck\u2019s Arch Surg"},{"key":"B24","article-title":"Use of methylene blue in intraoperative search of parathyroid glands","volume":"9","author":"Zubkov","year":"2018","journal-title":"Int Res J"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24237","article-title":"The feasibility of indocyanine green fluorescence imaging for identifying and assessing the perfusion of parathyroid glands during total thyroidectomy","volume":"113","author":"Zaidi","year":"2016","journal-title":"J Surg Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"W9","DOI":"10.1308\/147870807X160434","article-title":"Prolonged postoperative altered mental status after methylene blue infusion during parathyroidectomy: A case report and review of the literature","volume":"89","author":"Khan","year":"2007","journal-title":"Ann R Coll Surg Engl"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20581","article-title":"Parathyroid surgery and methylene blue: A review with guidelines for safe intraoperative use","volume":"119","author":"Pollack","year":"2009","journal-title":"Laryngoscope"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1177\/1553350615613450","article-title":"Utility of indocyanine green fluorescence imaging for intraoperative localization in reoperative parathyroid surgery","volume":"26","author":"Sound","year":"2015","journal-title":"Surg Innovation"},{"key":"B29","article-title":"Photodynamic vvisualisation of paratyroid glands \u2013 results of clinical use eng","author":"Sleptsov","year":"2009","journal-title":"Klinicheskaia i Eksperimentalnaia Tireoidologiia"},{"key":"B30","article-title":"Clinical application of 5-aminolevulinic acid: A useful and feasible new method for intraoperative identification of pathological and normal parathyroid during endocrine neck surgery","volume":"21","author":"Takeuchi","year":"2004","journal-title":"Endocrine Surg"},{"key":"B31","article-title":"L Beselia Study of intraoperative indocyanine green angiography effectiveness for identification of parathyroid gland total thyroidectomy","volume":"314","author":"Parfentiev","year":"2021","journal-title":"Georgian Med News"},{"key":"B32","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1177\/1553350620956437","article-title":"Use of indocyanine green and fluorescence angiography in parathyroid surgery: A feasibility study","volume":"27","author":"Maser","year":"2020","journal-title":"Surg Innovation"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2018.12.074","article-title":"Prediction of hypocalcemia after total thyroidectomy using indocyanine green angiography of parathyroid glands: a simple quantitative scoring system","volume":"27","author":"G\u00e1lvez-Pastor","year":"2020","journal-title":"Am J Surg"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-018-0834-6","article-title":"Application of a fluorescence imaging system with indocyanine green to protect the parathyroid gland intraoperatively and to predict postoperative parathyroidism","volume":"35","author":"Jin","year":"2018","journal-title":"Adv Ther"},{"key":"B35","doi-asserted-by":"publisher","first-page":"47","DOI":"10.14341\/serg2014147-52","article-title":"The use of chromothyrolymphography for selection of surgical volume in patients with thyroid cancer","volume":"8","author":"Romanchishen","year":"2014","journal-title":"Endocrine Surg"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2023.1206881\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T16:16:57Z","timestamp":1699546617000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2023.1206881\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,8]]},"references-count":35,"alternative-id":["10.3389\/fendo.2023.1206881"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2023.1206881","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,8]]},"article-number":"1206881"}}