{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:06:21Z","timestamp":1784304381482,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2019,7,14]],"date-time":"2019-07-14T00:00:00Z","timestamp":1563062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Molecules"],"abstract":"<jats:p>Injury to parathyroid glands during thyroid and parathyroid surgery is common and postoperative hypoparathyroidism represents a serious complication. Parathyroid glands possess a unique autofluorescence in the near-infrared spectrum which could be used for their identification and protection at an early stage of the operation. In the present study parathyroid autofluorescence was visualized intraoperatively using a standard Storz laparoscopic near-infrared\/indocyanine green (NIR\/ICG) imaging system with minor modifications to the xenon light source (filtered to emit 690 nm to 790 nm light, less than 1% in the red and green above 470 nm and no blue light). During exposure to NIR light parathyroid tissue was expected to show autofluorescence at 820 nm, captured in the blue channel of the camera. Over a period of 5 years, we investigated 205 parathyroid glands from 117 patients. 179 (87.3%) glands were correctly identified by their autofluorescence. Surrounding structures such as thyroid, lymph nodes, muscle, or adipose tissue did not reveal substantial autofluorescence. We conclude that parathyroid glands can be identified by their unique autofluorescence at an early stage of the operation. This may help to preserve these fragile structures and their vascularization and lower the rate of postoperative hypocalcemia.<\/jats:p>","DOI":"10.3390\/molecules24142560","type":"journal-article","created":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T04:55:27Z","timestamp":1563166527000},"page":"2560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Parathyroid Autofluorescence\u2014How Does It Affect Parathyroid and Thyroid Surgery? A 5 Year Experience"],"prefix":"10.3390","volume":"24","author":[{"given":"Roland","family":"Ladurner","sequence":"first","affiliation":[{"name":"Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Lerchenberger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah","family":"Al Arabi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia K. S.","family":"Gallwas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Maistr. 11, 80337 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1501-1912","authenticated-orcid":false,"given":"Herbert","family":"Stepp","sequence":"additional","affiliation":[{"name":"Laser-Research Laboratory, LIFE-Center, Ludwig Maximilians University Munich, Grosshadern Medical Campus, Feodor-Lynen-Str. 19, 81377 Munich, Germany"},{"name":"Department of Urology, Ludwig Maximilians University Munich, Grosshadern Medical Campus, Marchioninistrasse 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8932-4201","authenticated-orcid":false,"given":"Klaus K. J.","family":"Hallfeldt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/00005537-200204000-00003","article-title":"Incidence of Inadvertent Parathyroid Removal During Thyroidectomy","volume":"112","author":"Lin","year":"2002","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1067\/msy.2003.61","article-title":"The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients","volume":"133","author":"Thomusch","year":"2003","journal-title":"Surgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s00423-008-0366-7","article-title":"Complications to thyroid surgery: Results as reported in a database from a multicenter audit comprising 3,660 patients","volume":"393","author":"Bergenfelz","year":"2008","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1002\/jbmr.483","article-title":"Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research","volume":"26","author":"Bilezikian","year":"2011","journal-title":"J. Bone Miner. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"680","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":"Br. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1002\/bjs.8814","article-title":"Systematic review of intravenous methylene blue in parathyroid surgery","volume":"99","author":"Patel","year":"2012","journal-title":"Br. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1002\/hed.20416","article-title":"Adverse neurologic effect of methylene blue used during parathyroidectomy","volume":"28","author":"Patel","year":"2006","journal-title":"Head Neck"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.jamcollsurg.2006.12.030","article-title":"Methylene-Blue\u2013Associated Encephalopathy","volume":"204","author":"Sweet","year":"2007","journal-title":"J. Am. Coll. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1177\/000313480707300819","article-title":"Intra-operative parathyroid identification using methylene blue in parathyroid surgery","volume":"73","author":"Han","year":"2007","journal-title":"Am. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"534","DOI":"10.5694\/j.1326-5377.2008.tb02168.x","article-title":"Serotonin toxicity precipitated by concomitant use of citalopram and methylene blue","volume":"189","author":"Khavandi","year":"2008","journal-title":"Med. J. Aust."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s12028-009-9206-z","article-title":"Methylene Blue-Associated Serotonin Syndrome: A \u2018Green\u2019 Encephalopathy After Parathyroidectomy","volume":"11","author":"Rowley","year":"2009","journal-title":"Neurocritical Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1002\/hed.23384","article-title":"Intraoperative near-infrared fluorescence imaging of parathyroid adenomas with use of low-dose methylene blue","volume":"36","author":"Schaafsma","year":"2014","journal-title":"Head Neck"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111","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":"2018","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1007\/s00268-010-0621-2","article-title":"Fluorescence-guided minimally invasive parathyroidectomy: Clinical experience with a novel intraoperative detection technique for parathyroid glands","volume":"34","author":"Prosst","year":"2010","journal-title":"World J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1002\/lary.21857","article-title":"Intraoperative photodynamic detection of normal parathyroid glands using 5-aminolevulinic acid","volume":"121","author":"Suzuki","year":"2011","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1272\/jnms.81.84","article-title":"Identification of Pathological and Normal Parathyroid Tissue by Fluorescent Labeling with 5-aminolevulinic Acid during Endocrine Neck Surgery","volume":"81","author":"Takeuchi","year":"2014","journal-title":"J. Nippon. Med Sch."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"024017","DOI":"10.1117\/1.2717137","article-title":"Comparison of visible and near-infrared wavelength-excitable fluorescent dyes for molecular imaging of cancer","volume":"12","author":"Adams","year":"2007","journal-title":"J. Biomed. Opt."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"041303","DOI":"10.1117\/1.2953185","article-title":"Molecular imaging with optics: Primer and case for near-infrared fluorescence techniques in personalized medicine","volume":"13","author":"Rasmussen","year":"2008","journal-title":"J. Biomed. Opt."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"512","DOI":"10.21037\/gs.2016.10.06","article-title":"Indocyanine green-enhanced fluorescence for assessing parathyroid perfusion during thyroidectomy","volume":"5","author":"Lavazza","year":"2016","journal-title":"Gland. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"775","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":"ref_21","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1002\/jso.24240","article-title":"The utility of indocyanine green near-infrared fluorescent imaging in the identification of parathyroid glands during surgery for primary hyperparathyroidism","volume":"113","author":"Zaidi","year":"2016","journal-title":"J. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1002\/bjs.10101","article-title":"Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery","volume":"103","author":"Belfontali","year":"2016","journal-title":"Br. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"579","DOI":"10.21037\/gs.2017.09.01","article-title":"The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation","volume":"6","author":"Jitpratoom","year":"2017","journal-title":"Gland Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1002\/bjs.10783","article-title":"Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery","volume":"105","author":"Sadowski","year":"2018","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"067012","DOI":"10.1117\/1.3583571","article-title":"Near-infrared autofluorescence for the detection of parathyroid glands","volume":"16","author":"Paras","year":"2011","journal-title":"J. Biomed. Opt."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.surg.2013.06.046","article-title":"A novel optical approach to intraoperative detection of parathyroid glands","volume":"154","author":"McWade","year":"2013","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4574","DOI":"10.1210\/jc.2014-2503","article-title":"Label-free Intraoperative Parathyroid Localization With Near-Infrared Autofluorescence Imaging","volume":"99","author":"McWade","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.surg.2015.06.047","article-title":"Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection","volume":"159","author":"McWade","year":"2016","journal-title":"Surgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1007\/s00268-016-3571-5","article-title":"Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study","volume":"40","author":"Breuskin","year":"2016","journal-title":"World J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.jamcollsurg.2016.04.049","article-title":"Cutting Edge in Thyroid Surgery: Autofluorescence of Parathyroid Glands","volume":"223","author":"Falco","year":"2016","journal-title":"J. Am. Coll. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3140","DOI":"10.1007\/s00464-016-5338-3","article-title":"Intraoperative near-infrared autofluorescence imaging of parathyroid glands","volume":"31","author":"Ladurner","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1308\/rcsann.2017.0102","article-title":"Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery","volume":"100","author":"Ladurner","year":"2018","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4646","DOI":"10.1210\/jc.2016-2558","article-title":"Intraoperative Real-Time Localization of Normal Parathyroid Glands with Autofluorescence Imaging","volume":"101","author":"Song","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.surg.2017.06.022","article-title":"Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: A before and after controlled study","volume":"163","author":"Benmiloud","year":"2018","journal-title":"Surgery"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3737","DOI":"10.1007\/s00464-017-5424-1","article-title":"Increased identification of parathyroid glands using near-infrared light during thyroid and parathyroid surgery","volume":"31","author":"Falco","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1245\/s10434-018-6364-2","article-title":"Detection of Parathyroid Autofluorescence Using Near-Infrared Imaging: A Multicenter Analysis of Concordance Between Different Surgeons","volume":"25","author":"Kahramangil","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jamcollsurg.2017.10.015","article-title":"Near-Infrared Autofluorescence Image-Guided Parathyroid Gland Mapping in Thyroidectomy","volume":"226","author":"Kim","year":"2018","journal-title":"J. Am. Coll. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.jamcollsurg.2018.12.044","article-title":"Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy","volume":"228","author":"Dip","year":"2019","journal-title":"J. Am. Coll. Surg."},{"key":"ref_39","unstructured":"McWade, M. (2019, January 26). Development of an intraoperative tool to detect parathyroid gland autofluorescence. Available online: https:\/\/etd.library.vanderbilt.edu\/available\/etd-04152016-131447\/unrestricted\/McWade.pdf."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Thomas, G., McWade, M.A., Sanders, M.E., Sol\u00f3rzano, C.C., McDonald, W.H., and Mahadevan-Jansen, A. (2016). Identifying the novel endogenous near-infrared fluorophore within parathyroid and other endocrine tissues. Biomed. Opt.","DOI":"10.1364\/CANCER.2016.PTu3A.5"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"E1499","DOI":"10.1210\/jc.2011-3366","article-title":"Differential Gene Expression by Oxyphil and Chief Cells of Human Parathyroid Glands","volume":"97","author":"Ritter","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.regpep.2010.06.002","article-title":"Secretogranin III in human neuroendocrine tumours: A comparative immunohistochemical study with chromogranins A and B and secretogranin II","volume":"165","author":"Grimelius","year":"2010","journal-title":"Regul. Pept."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1097\/00000478-198811000-00008","article-title":"Immunological Studies on the Occurrence and Properties of Chromogranin A and B and Secretogranin II in Endocrine Tumors","volume":"12","author":"Weiler","year":"1988","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"26117","DOI":"10.1364\/OE.20.026117","article-title":"Optical needle endoscope for safe and precise stereotactically guided biopsy sampling in neurosurgery","volume":"20","author":"Brucker","year":"2012","journal-title":"Opt. Express"}],"container-title":["Molecules"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1420-3049\/24\/14\/2560\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:05:28Z","timestamp":1760187928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1420-3049\/24\/14\/2560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,14]]},"references-count":44,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2019,7]]}},"alternative-id":["molecules24142560"],"URL":"https:\/\/doi.org\/10.3390\/molecules24142560","relation":{},"ISSN":["1420-3049"],"issn-type":[{"value":"1420-3049","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,14]]}}}