Endocrine Abstracts

Bioluminescence is bringing new and exciting possibilities to the field of endocrine surgery, because we are able to better harness the property of autofluorescence of the parathyroid glands. Parathyroid glands have an inherent ability to produce infra-red autofluorescence at the wavelength of 820 nm to 830 nm, if the gland absorbs light at the wavelength of 750 nm. With highly sensitive technology and the ability to filter out other reflected light and noise, it is now possible to identify the infra-red light emitted by parathyroid glands and cells. We would like to share a case of primary hyperparathyroidism that could not be identified and localised pre-operatively, but a right thyroid nodule was identified. Intra-operatively, a neck exploration was strongly suggestive of an intrathyroidal parathyroid lesion in the known right thyroid nodule. With the aid of a specialised near infra-red (NIR) camera, autofluorescence was detected from the thyroid nodule, helping to confirm our preliminary diagnosis, and proceeded with a right hemithyroidectomy. Intra-operative measurement of the parathyroid hormone confirmed an adequate drop in the parathyroid hormone levels after the excision of the right hemithyroid. Post-operative pathological assessment also confirmed the presence of parathyroid tissue in the thyroid tumour. The accuracy of parathyroid gland detection can be greatly enhanced with the employment of highly sensitive NIR technology, and help shape the development better strategies to approach parathyroid surgery. Other applications of this technology in the setting of neck surgery will be discussed.