Parathyroid identification by methylene blue infusion

Abstract

The intravenous infusion of methylene blue was investigated as a procedure that would identify parathyroid glands during operation in 17 patients with primary hyperparathyroidism. The dye was found to stain all adenomas, most hyperplastic glands and occasionally normal parathyrodi glands. In addition, the frequency of glandular staining was directly related to the size of the gland, although size and histology may have been independent variables. Methylene blue infusion is a safe effective method of localizing abnormal parathyroid glands.

Intraoperative adjuncts in surgery for primary hyperparathyroidism

“…There are no prospective studies published on this topic. Many retrospective studies describe its use [90][91][92][93][94][95][96][97][98][99][100][101][102][103], five of them originating from the same center [104][105][106][107][108]. Two of them showed a small but significant reduction in the duration of surgery [107,109].…”

Methylene Blue-Associated Serotonin Syndrome: A ‘Green’ Encephalopathy After Parathyroidectomy

“…In vitro experiments also show that intravenous doses of MB inhibit monoamine oxidase (MAOI) [7] and may have direct hippocampal neuronal toxicity in rats [5]. The use of MB greatly aids visualization of the parathyroid glands during parathyroidectomy and is given as a preoperative infusion of 5-10 mg/ kg over 45-60 min [1,2,[8][9][10]. After intravenous infusion, it is rapidly accumulated in the parathyroid glands, and animal studies demonstrate rapid CNS accumulation after intravenous administration [11].…”

“…Methylene blue (MB) infusion allows direct visualization intraoperatively of the parathyroid glands during parathyroidectomy and is generally safe [1,2]. However, recent reports suggest neurological toxicity and post-operative altered mental state with an uncertain mechanism [3][4][5].…”

Photochemotherapy of experimental colonic tumours with intra-tumorally applied methylene blue

“…MB + is characterised by a low toxicity and high tumour specificity [17][18][19]. As an important vital dye, it can be used for intraoperative in vivo staining of different tumours [20,21]. As a redox indicator, MB + is rapidly reduced to stainless MBH, which is not photodynamically active when given to the organism intravenously [22].…”