{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:50:07Z","timestamp":1782190207117,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"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. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Postoperative hypoparathyroidism remains a common complication after total thyroidectomy. This study aimed to assess whether combining near-infrared autofluorescence (NIRAF) imaging with carbon nanoparticle suspension (CN) improves parathyroid gland (PG) identification and functional preservation in patients undergoing total thyroidectomy for papillary thyroid carcinoma (PTC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 80 patients with PTC undergoing total thyroidectomy with central neck dissection (CND) were randomly divided into two groups. The CN group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) received CN alone to distinguish PGs, whereas the NIRAF\u2009+\u2009CN group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) underwent combined CN and NIRAF imaging for PG identification. Data collected included operative time, counts of identified, incidentally removed, and autotransplanted PGs, and lymph nodes numbers. Serum calcium and parathyroid hormone (PTH) levels were compared preoperatively and postoperatively (on day 1, and at 1, 3, and 6 months) between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The NIRAF\u2009+\u2009CN group identified significantly more PGs than the CN group (147\/160 [91.9%] vs. 135\/160 [84.4%],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), with a lower rate of incidentally removed PGs (5.0% vs. 15.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.263) and a higher autotransplantation rate (20.0% vs. 15.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.770). On postoperative day 1, serum PTH levels were significantly higher in the NIRAF\u2009+\u2009CN group (19.86\u2009\u00b1\u200911.15\u2005pg\/mL) than in the CN group (13.82\u2009\u00b1\u20099.13\u2005pg\/mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010), while calcium levels and PTH at later time points (1, 3, 6 months) showed no significant intergroup differences. The incidence of transient hypoparathyroidism was 25.0% in the NIRAF\u2009+\u2009CN group vs. 37.5% in the CN group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.228), and permanent hypoparathyroidism occurred in 2.5% of the NIRAF\u2009+\u2009CN group compared with 7.5% of the CN group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.615).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The combined use of NIRAF and CN enhances intraoperative PG preservation and improves early parathyroid function.<\/jats:p>\n                  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