Discussion
thyrotoxicosisA, hypoparathyroidism
HYPOCALCAEMIA, POSTOPERATIVE HYPOPARATHYROIDISM, HYPOPARATHYROIDISM, THYROTOXICOSIS
The main result of this RCT, which compared the use of FluobeamA subanalysis showed that the use of autofluorescence was, however, beneficial in patients who underwent central lymph node clearance; the rate of low levels of PTH on the first postoperative day was 8.3 per cent in the intervention group compared with 33.7 per cent in the control group (More parathyroid glands were detected during operation in the intervention group compared with the control group, including in the surgical specimen. Most glands in the specimen were detected by autofluorescence in the intervention group. In the intervention group, autotransplantation was performed in 51 of 286 patients (20.7 per cent) compared with 35 of 240 (14.6 per cent) in the control group (Because there was a difference in included patients, and in the rate of low PTH levels on the first postoperative day, between participating centres (Some 157 patients were treated after surgery for hypoparathyroidism, 31.1 per cent in the intervention group and 32.5 per cent in the control group (These results are only partly in agreement with those of a multicentre study by Benmiloud Postoperative calcium levels depend on several factors, including preoperative calcium level, the level of 25-hydroxyvitamin D, thyrotoxicosisA low PTH level on the first postoperative day was chosen as primary outcome in the present study because postoperative PTH concentration is considered the earliest and most sensitive predictor of postoperative hypoparathyroidismIt may be argued that the measured PTH level should be evaluated in the context of the measured calcium level; that is, a patient could present with hypoparathyroidism with a normal PTH level. There is, however, no firm accepted definition of an inappropriately low PTH level in the face of hypocalcaemia.In the present study, the difference in the rate of low PTH on the first postoperative day between the intervention and control groups failed to reach statistical significance. Broadly in agreement, there was also no difference in PTH levels on the day after surgery between the intervention and control groups in other RCTsThe power calculation for the primary outcome in this study was based on the results from observational studiesIn agreement with previous studiesThere was no difference in the number of patients treated for hypoparathyroidism after surgery between the two groups (32.1 per cent in intervention group and 32.5 per cent in control group). The decision to treat hypoparathyroidism was based on local hospital guidelines, which indeed may have differed considerably. The patients were, however, followed clinically and with measurement of calcium and PTH levels until these normalized, although one patient refused follow-up. In most patients, medical treatment of hypoparathyroidism could be terminated. Some 16 patients were still being treated for hypoparathyroidism after 6 months, 6 (2.4 per cent) in the intervention group and 10 (4.2 per cent) in the control group. The 6-month threshold is well established; however, it is known that some patients may recover beyond that time pointThis RCT was performed at the time of the COVID-19 pandemic, which proved be very challenging. The epidemiological situation with restrictions for patients and hospitals, including lockdowns, travel restrictions, and restrictions on the types of operation performed, varied greatly over time and among countries and centres. Delay in delivery of the FluobeamThe number of surgeons involved varied between the centres, but this probably did not influence the combined results. Furthermore, experience with the FluobeamIn the context of these limitations, it can be concluded that the use of autofluorescence of the parathyroid gland, here employing Fluobeam