A-207 impact of the use of autofluorescence for detection of parathyroid glands during thyroidectomy: a randomised controlled trial

Abstract Background Hypoparathyroidism is the most frequent complication to thyroid surgery. Recently techniques for auto fluorescence have been introduced in order to visualise and protect the parathyroid glands during surgery. Only a few randomised controlled trials have been reported. Methods A multi-center randomised controlled trial to investigate the use of FluobeamÒLX to visualise the parathyroid glands during first time surgery with total thyroidectomy compared to no use. There was no restriction in the indication for thyroid surgery. The primary endpoint was the rate parathyroid hormone (PTH) levels below the lower reference limit the day after surgery. Results Some 486 patients were randomised to the use of FluobeamÒLX (n=246) or controls (n=240). Mean age was 51 (s.d. 15) years and 389 (80.0 per cent) were women. The rate of low levels of PTH on the first postoperative day was 64 (26.0 per cent) in the FluobeamÒgroup and 77 (32.1 per cent) in the control group (p=0.141). Sub-analysis of 174 patients undergoing central lymph node clearance showed that 15 of 82 (18.3 per cent) patients in the FluobeamÒgroup and 31 of 92 (33.7 per cent) in the control group (p=0.021) had low levels of PTH the day after surgery. Conclusion The use of auto-fluorescence to detect parathyroid glands during thyroidectomy did not reduce the rate of low PTH levels at postoperative day one significantly. However, it was beneficial in sub-groups of patients.