Fluorescence Angiography Impacting Surgical Heuristics in Subtotal Parathyroidectomy

Parathyroidectomy is the primary treatment for various forms of hyperparathyroidism, necessitating precise localization and excision of hyperfunctioning glands. Traditional imaging modalities like technetium-99m (99mTc)-sestamibi and ultrasound have variable success rates. Indocyanine green (ICG) Angiography, utilizing near-infrared fluorescence, offers a novel approach to intraoperative gland identification. A 68-year-old male with secondary hyperparathyroidism underwent preoperative localization with ultrasound and 99mTc-sestamibi, identifying a parathyroid gland posterior to the right thyroid lobe. Four-dimensional computed tomography revealed additional left-sided lesions, which were difficult to differentiate from thyroid nodules. Subtotal parathyroidectomy was performed using ICG angiography. Two left sided intrathyroidal parathyroid glands were visualised and excised without hemithyroidectomy. ICG facilitated real-time identification of highly perfused parathyroid tissue, guiding surgical decision-making, and preserving thyroid integrity. ICG Angiography represents a valuable adjunct in challenging parathyroid surgeries by enhancing intraoperative localisation and differentiation of parathyroid glands from thyroid tissue. Its ability to visualise parathyroid perfusion offers a promising tool for improving surgical outcomes and warrants further investigation into its correlation with parathyroid function.