Intraoperative Parathyroid Imaging in Hypoparathyroidism

In hypoparathyroidism, the body cannot produce enough parathyroid hormone (PTH) from the parathyroid glands. PTH  is an important hormone that regulates phosphate and calcium levels by controlling calcium absorption during digestion, and the breakdown of bone tissue. When too little PTH is made, blood levels of calcium drop and phosphate levels rise, leading to symptoms that can range from muscle aches and tingling in the fingers and toes to anxiety and depression.

The most common cause of hypoparathyroidism (although others are known) is the removal or destruction of the parathyroid glands during neck surgery, such as for thyroid disease.

About the parathyroid glands

The parathyroid glands are four tiny nodes in the neck, near the back of the thyroid gland. Each parathyroid gland is about the size of a grain of rice — making them difficult to see and avoid during neck or thyroid gland surgery. Even the best surgeons may not be able to avoid these glands.

What is intraoperative parathyroid imaging?

Intraoperative parathyroid imaging is a technique that allows the surgical team to visualize the parathyroid glands during surgery. This can help them avoid damaging or removing the glands by mistake.

There are different ways to image the glands.

Near infra-red autofluorescence

The parathyroid glands auto-fluoresce — glow — under near infra-red light (NIRL). By using a NIRL light during surgery, surgeons can significantly improve their ability to see the glands.

Injected fluorophores

Fluorophores are molecules that “glow” when excited by particular portions of the light spectrum. Some researchers have demonstrated that injecting patients with a harmless fluorophore prior to surgery can allow them to visualize the parathyroid glands during surgery.

Laser speckle contrast imaging (LSCI)

LSCI is a technique surgeons can use to check the adequacy of blood flow to the parathyroid glands during surgery. One way the parathyroid glands are affected by surgery is through damage to their blood supply.

If even one parathyroid gland is kept healthy throughout a surgery, patients are much less likely to develop hypoparathyroidism.

Last updated: Aug. 21, 2020

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