Successful Localization of Abnormal Parathyroid Gland Using Ultrasound-Guided Methylene Blue Dye Injection in the Reoperative Neck

Abstract

Persistent or recurrent hyperparathyroidism is a challenging problem for endocrine surgeons. The aim of this study was to review our experience using ultrasound-guided (US-G) methylene blue dye injection for the localization and removal of abnormal parathyroid glands in patients having primary hyperparathyroidism and previous neck surgery. Between January 2012 and May 2013, six consecutive patients with primary hyperparathyroidism (PHPT) and previous neck surgery underwent focused parathyroidectomy with the use of US-G methylene blue dye injections to localize the presumed parathyroid adenoma were included in the study. We analyzed the data of six patients who underwent reoperative parathyroid surgery using US-G methylene blue dye injection retrospectively. The dye injection was performed just prior to surgery. All patients were successfully treated for their hyperparathyroidism which was confirmed by at least 50 % drop in intraoperative parathormone level 10 min after resection. There were no complications related with US-G dye injection or with surgery. US-G methylene blue dye injection is a cheap, safe, and effective method for localization of diseased parathyroid glands and guiding surgery in the reoperative neck.

The contribution of the preoperative methylene blue staining method to the surgical performance of parathyroid adenomas with difficult localization

“…Parathyroid adenomas, which cannot be excised with cervical exploration, may be indistinguishable from ectopic and/or other lesions because of their small size and soft consistency (17)(18). The second surgical intervention is very risky after an unsuccessful and extended surgical intervention, and the risk of developing complications is very high (19)(20). The cases (12 patients) that could not be excised even with cervical exploration in the clinic were excised with minimally invasive surgery with methylene blue staining.…”

Persistent and Recurrent Primary Hyperparathyroidism: Intraoperative Supplemental Methods, Basic Principles of Surgery, and Other Treatment Options

“…No local or systemic complications related to methylene blue have been reported. [ 18 , 19 ] In addition, it has been reported that with the intravenous administration of methylene blue, the pathological parathyroid glands can be identified quickly by calorimetrical measurement. However, false-positive staining has been reported in normal parathyroid glands, lymph nodes, thyroid tissue, thymic tissue, and fatty tissue.…”