The Role of Methylene Blue in Identification of Parathyroid Glands during Total Thyroidectomy

Introduction: Methylene blue (MB) spray was used to identify the parathyroid gland’s location. The parathyroidsare capable of absorption of the blue staining and regaining their original yellow color in three minutes, however,other tissues take more time.Aim of work: To evaluate safety and efficacy of MB spray in identifying parathyroid glands during totalthyroidectomy.Patients and methods: This randomized prospective study included 30 patients aged ≥18 years with variousthyroid diseases undergoing total thyroidectomy using MB spray for parathyroid gland detection. Findings werecompared with 30 patients who underwent total thyroidectomy using conventional methods without MB spray.Results: No substantial variations existed regarding identification of parathyroids and recurrent laryngeal nerves.There was only one case that developed transient hypo-calcemic symptoms in group I and another case in groupII that improved with medical treatment. There were no any recorded cases that suffered from post-operativerecurrent laryngeal nerve injury symptoms, wound infection, seroma or haematoma collection. The mean value ofpostoperative ionized calcium levels was 4.32 ± 0.76 mg/dl and of total calcium levels was 8.47±1.55 mg/dl. Themean value of postoperative parathyroid hormone levels was 19.51 ± 5.64 pg/ml.Conclusion: MB spraying is technically viable and secure but has no significant role in preservation of theparathyroid glands throughout thyroidectomy, with no value in minimizing the incidence of postoperativehypocalcemia. Meticulous dissection is the fundamental component for conservation of the parathyroid glandsthroughout thyroidectomy.