Methylene Blue Gland Localization

Background: Total parathyroidectomy raises problems in preoperatively identifying and intraoperatively locating all parathyroid glands. In 2007, we prepared 1% methylene blue injections that led to a favorable outcome. Subjects and Materials: Twelve subjects with secondary hyperparathyroidism indicated for total parathyroidectomy based on the Japan Society for Dialysis Therapy guidelines were treated. Methods: Methylene blue at 5 mg/kg of body weight was bottled in 100 ml of normal saline and administered intravenously over 30 to 60 minutes after subjects were anesthetized or as surgeons required. Results: Dye use enabled four glands in 10 cases and 5 glands in 1 to be removed, compared to 4 glands identified preoperatively in just 3 cases. Surgery lasted from 92 to 242 minutes. Serum iPTH, calcium, phosphorus levels were reduced in all cases. Conclusions: Injecting 1% methylene blue enabled successful parathyroid-grand removal in many cases without serious side effects.