Efficacy of indocyanine green fluorescence in predicting parathyroid vascularization during thyroid surgery

Head Neck. 2019 Sep;41(9):3276-3281. doi: 10.1002/hed.25837. Epub 2019 Jun 17.


Background: We examined the value of indocyanine green (ICG) fluorescence angiography in predicting parathyroid vascularization following thyroid and central compartment surgeries.

Methods: Data were prospectively collected on adult patients undergoing thyroid and/or central compartment surgeries. Outcomes were compared in surgeries performed with and without ICG use. ICG scoring was used to quantify the vascularity of parathyroid glands.

Results: One hundred eleven patients were included; 43 (38.7%) patients underwent ICG injections. There was no significant difference in mean parathyroid hormone (PTH) changes at the end of surgery (29.24 vs 23.48 pg/mL, P = .38), symptomatic hypocalcemia (7.9% vs 3.9%, P = .37), or length of stay (1.095 ± 0.22 vs 0.912 ± 0.07 days, P = .51) between surgeries performed with and without ICG. The average vascularization score among individuals undergoing ICG angiography was 2.89 out of a maximum of 8 points.

Conclusion: Low-flow ICG patterns are not associated with postoperative PTH changes or transient hypocalcemia and may lead to unnecessary parathyroid autotransplantation.

Keywords: ICG; angiography; autotransplantation; parathyroid; thyroid.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Angiography*
  • Female
  • Fluorescence
  • Fluorescent Dyes*
  • Humans
  • Hypocalcemia / epidemiology
  • Indocyanine Green*
  • Male
  • Optical Imaging
  • Parathyroid Glands / blood supply*
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Hormone / blood
  • Postoperative Complications / blood
  • Postoperative Complications / epidemiology
  • Predictive Value of Tests
  • Retrospective Studies
  • Thyroidectomy / adverse effects*


  • Fluorescent Dyes
  • Parathyroid Hormone
  • Indocyanine Green