To evaluate the clinical efficacy of the immunocolloidal gold technique (ICGT), near-infrared autofluorescence imaging (NIRAF), and visual recognition in the intraoperative identification and preservation of parathyroid glands (PTGs).

A total of 227 patients undergoing thyroid surgery at Hefei Second People's Hospital from February 2020 to December 2021 were enrolled and divided into three groups based on the parathyroid identification method used: visual recognition group (n=73), NIRAF group (n=76), and ICGT group (n=78). The differences in intraoperative PTG identification, trends in parathyroid hormone (PTH) and serum calcium levels, and postoperative complications were compared among the groups.

In the visual recognition group, 106 suspected PTG samples were collected from 73 patients. The method demonstrated a specificity of 44%, sensitivity of 82.7%, misdiagnosis rate of 56%, and accuracy of 73.6%. In the NIRAF group, 118 samples were obtained from 76 patients, with a specificity of 83.9%, sensitivity of 95.4%, misdiagnosis rate of 16.1%, and accuracy of 92.4%. In the ICGT group, 133 samples were collected from 78 patients, with a specificity of 95.2%, sensitivity of 92.3%, misdiagnosis rate of 4.8%, and accuracy of 93.2%. Compared with visual recognition and NIRAF, ICGT demonstrated superior specificity and accuracy. No significant differences in PTH and serum calcium levels were observed among the three groups preoperatively or at 6 months postoperatively (P>0.05). However, at postoperative days 3 and 5, and at 1 and 3 months, both the ICGT and NIRAF groups exhibited significantly higher PTH and calcium levels than the visual recognition group (P<0.05), though there was no significant difference between ICGT and NIRAF (P>0.05). The incidence of postoperative hypocalcemia was 24.7% in the visual recognition group, 10.5% in the NIRAF group, and 7.7% in the ICGT group, with the visual group showing a significantly higher rate (P<0.05). The incidence of permanent hypoparathyroidism was 2.7% in the visual group, 0 in the NIRAF group, and 0 in the ICGT group, with no significant intergroup difference (P>0.05).

ICGT demonstrates high specificity and accuracy in identifying PTGs during thyroidectomy, effectively reducing postoperative complications and showing strong clinical value in preserving parathyroid function.