Currently, about 20 million Americans have some form of thyroid disease. Thyroid disease occurs when the thyroid gland does not supply the appropriate amount of thyroid hormone needed. Thyroid and parathyroid diseases combine the fields of endocrinology and oncology leading to a complex combination of pathological conditions. When the disease cannot be treated by other methods, surgical means are used to remove the diseased gland(s). They are around 100,000 thyroid surgeries each year in the US to remove part or the entire thyroid. Complications occur when the parathyroid is accidentally injured or removed during thyroidectomies. This happens because Parathyroid glands are difficult to distinguish from the thyroid and surrounding tissues in the neck. The situation is further complicated by the glands'variability in position. Surgeons must ultimately rely on visual inspection to identify the different tissues, which can be subjective and inconclusive. Damage to the gland(s) can cause hypoparathyroidsim and hypocalcemia resulting in serious and deleterious side effects. In a recent (June 2011) publication, the PI Prof. Mahadevan-Jansen's group at Vanderbilt University reported for the first time the breakthrough finding that the Parathyroid Gland has a unique autofluorescence signature in the NIR under illumination at 785nm. The average fluorescent intensity of the parathyroid is over 6 times higher than other tissues in the neck area in a study of over 44 patients.
The specific aim of this proposal is to build upon that work and it seeks to a) Characterize the the near-infrared fluorescence signatures of thyroid and parathyroid tissue in order to understand the source of this higher autofluorescence for the parathyroid gland b) To develop prototype instrumentation that provides imaging as well as point analysis including a software interface to implement and automate data acquisition and to provide real-time feedback The goal of this proposal is to develop an intra-operative detection platform for the parathyroid glands.

Public Health Relevance

This goals of this project is to build an intra-operative detector (for surgeons) that can uniquely detect the parathyroid glands based on the technique of near-infrared (NIR) autofluorescence. There are around 100,000 thyroid surgeries each year in the US to remove part or the entire thyroid. Upto 20% of these surgeries lead to accidental removal of the parathyroid glands since they are difficult to distinguish from the thyroid and other neck tissue. The parathyroid glands responsible for the production of parathyroid hormone in order to maintain calcium homeostasis throughout the body. Their removal or injury could lead to health problems that result in lifelong medications to deal with.

National Institute of Health (NIH)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Small Business Technology Transfer (STTR) Grants - Phase I (R41)
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Special Emphasis Panel (ZRG1-SBIB-T (10))
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Krosnick, Steven
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Anasys Instruments Corporation
Santa Barbara
United States
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McWade, Melanie A; Sanders, Melinda E; Broome, James T et al. (2016) Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery 159:193-202
McWade, Melanie A; Paras, Constantine; White, Lisa M et al. (2014) Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab 99:4574-80
McWade, Melanie A; Paras, Constantine; White, Lisa M et al. (2013) A novel optical approach to intraoperative detection of parathyroid glands. Surgery 154:1371-7; discussion 1377
Yusof, Adlina Mohd; Kothandaraman, Shankaran; Zhang, Xiaoli et al. (2013) Development of a calcium-sensing receptor molecular imaging agent. Surgery 154:1378-84; discussion 1384