Feasibility of using colloidal gold immunochromatography for point-of-care identification of parathyroid glands during thyroidectomy

Prevention of hypoparathyroidism: A step-by-step near-infrared autofluorescence parathyroid identification method

BACKGROUND

Hypoparathyroidism is an important factor that seriously affects the quality of life of patients after thyroidectomy. This study aimed to optimize the surgical procedure for parathyroid identification using near-infrared autofluorescence (NIRAF) during thyroidectomy.

METHODS

This was a prospective controlled study that included 100 patients with primary papillary thyroid carcinoma diagnosed in Beijing Tongren Hospital between June 2021 and April 2022 who were awaiting total thyroidectomy and bilateral neck dissection. The patients were randomly divided into an experimental group in whom step-by-step NIRAF imaging was used to identify parathyroid glands, and a control group in whom NIRAF was not used.

RESULTS

The number of parathyroid glands identified in the NIRAF group was higher than that in the control group (195 vs. 161, p=0.000, Z=-5.186). The proportion of patients with parathyroid glands inadvertently removed in the NIRAF group was lower than that in the control group (2.0% vs. 18.0%, respectively; p=0.008, χ^{2 =} 7.111). In the NIRAF group, we found that more than 95% of the superior parathyroid glands and more than 85% of the inferior parathyroid glands were identified before the dangerous phase, which was much higher than that in the control group. The incidences of temporary hypoparathyroidism, hypocalcemia, and symptomatic hypocalcemia were higher in the control group than those in the NIRAF group. On the first postoperative day, the average parathyroid hormone (PTH) level in the NIRAF group decreased to 38.1% of the preoperative level and that in the control group decreased to 20.0% of the preoperative level (p=0.000, Z=-3.547). On the third postoperative day, the PTH level in 74% of the patients in the NIRAF group recovered to normal levels, whereas it recovered in only 38% of the patients in the control group (p=0.000, χ^{2 =} 13.149). The PTH levels in all patients in the NIRAF group had recovered within 30 days after surgery, whereas one patient in the control group failed to return to the normal level 6 months after surgery and was diagnosed with permanent parathyroidism.

CONCLUSIONS

The step-by-step NIRAF parathyroid identification method can effectively locate the parathyroid gland and protect its function.

[Prevention and treatment of postoperative hypoparathyroidism]

Hypoparathyroidism is a failure of parathyroid glands characterized by reduced serum concentration of parathyroid hormone, hypocalcemia and hyperphosphatemia. The most common cause of hypoparathyroidism is resection or damage to parathyroid glands during thyroid surgery. Postoperative hypoparathyroidism is still an urgent problem, as it requires additional treatment and prolongs hospital-stay. Considering available literature data, the authors analyze various methods of intraoperative prevention of hypoparathyroidism.

Potential protection of indocyanine green on parathyroid gland function during near-infrared laparoscopic-assisted thyroidectomy: A case report and literature review

BACKGROUND

In recent decades, significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyro-idectomy. However, reliable and convenient technical means are still lacking. In this study, the reliability, safety and feasibility of near-infrared (NIR) laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection (CLND) were reported.

CASE SUMMARY

A 63-year-old female patient with a free previous medical history, was admitted to our department due to multiple thyroid nodules. Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B. Imaging examination of the neck showed no obvious enlarged lymph nodes. Fine needle aspiration biopsy suggested a papillary thyroid carcinoma. Combined with thyroid function examination, the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis. Considering the risk of invading the capsule and the patient's extreme anxiety, a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned. No significant abnormalities were found during preoperative examinations, except for an increased thyroid stimulating hormone level. The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND. During the operation, two right parathyroid glands (PGs) adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve (RLN) were examined by indocyanine green (ICG) fluorescence using a NIR fluorescence camera, and the PGs and RLN were reliably preserved. Considering the ICG-positive PG, prophylactic CLND was performed. The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.

CONCLUSION

During NIR laparoscopy-assisted thyroidectomy, ICG fluorescence may aid PG identification and protection.

Current diagnostic tools for coronaviruses-From laboratory diagnosis to POC diagnosis for COVID-19

The Coronavirus-2019 (COVID-19) pandemic has put tremendous strain on healthcare systems worldwide. It is challenging for clinicians to differentiate COVID-19 from other acute respiratory tract infections via clinical symptoms because those who are infected display a wide range of symptoms. An effective, point-of-care (POC) diagnostic tool could mitigate healthcare system strain, protect healthcare professionals, and support quarantine efforts. We believe that a POC tool can be developed that would be rapid, easy to use, and inexpensive. It could be used in the home, in resource-limited areas, and even in clinical settings. In this article, we summarize the current state of COVID-19 diagnostic methods and make a case for an all-in-one, highly sensitive POC assay that integrates antibody detection, protein detection, and serum cytokine detection to diagnose COVID-19 infection. We believe this article will provide insights into the current state of diagnostics for COVID-19, and promote additional research and tool development that could be exceptionally impactful.