Prediction of hypocalcemia after total thyroidectomy using indocyanine green angiography of parathyroid glands: a simple quantitative scoring system.

Abstract Background Hypocalcemia is one of the most common complications after total thyroidectomy. Recently, indocyanine green (ICG) angiography of the parathyroid glands (PGs) has been suggested as a reliable tool for predicting postoperative hypocalcemia. The aim of our study was to evaluate the performance of a simple quantitative score based on ICG angiography of the PGs (4-ICG score) for predicting postoperative hypocalcemia. Methods Thirty nine consecutive patients who underwent total thyroidectomy for multinodular goiter were included. For each patient, the 4-ICG score was calculated, adding the individual viability value of the four PGs. Discrimination and correlation analyses were performed. Results In 32/39 patients, the four PGs were identified. Patients with postoperative hypocalcemia (n=6, 19%) had a lower 4-ICG score (2.5 [1.8–3.3] vs. 4.0 [3.0–6.0]; p = .003). The 4-ICG score showed good discrimination in terms of predicting postoperative hypocalcemia (AUC=0.875 (0.710–0.965); p=.001) and a good correlation with postoperative parathyroid function. Conclusions The 4-ICG score predicts postoperative hypocalcemia and correlates well with postoperative parathyroid function in patients undergoing total thyroidectomy for multinodular goiter.