Rapid Intraoperative Localization of Parathyroid Glands Utilizing Methylene Blue Infusion

Kuriloff, Daniel B.; Sanborn, Kevin V.

doi:10.1016/j.otohns.2004.04.026

Cited by 55 publications

(44 citation statements)

References 19 publications

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“…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].…”

Section: Role Of Methylene Blue Dye Infusionmentioning

confidence: 99%

Intraoperative adjuncts in surgery for primary hyperparathyroidism

Harrison

Triponez

2009

Langenbecks Arch Surg

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Section: Role Of Methylene Blue Dye Infusionmentioning

confidence: 99%

Intraoperative adjuncts in surgery for primary hyperparathyroidism

Harrison

Triponez

2009

Langenbecks Arch Surg

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“…MB aids efficient and rapid identification of abnormal glands in eutopic and, especially, in ectopic locations in the neck. As a result, both the amount of tissue dissection and the operating time have been shown to be significantly reduced with the use of MB, [11][12][13] which must be better and safer for what is a generally older population of patients (as demonstrated in this series, where there was an average age of 60 years with a range of 15 to 89 years).…”

Section: Discussionmentioning

confidence: 86%

The value and role of low dose methylene blue in the surgical management of hyperparathyroidism

Bewick

Pfleiderer

2014

annals

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INTRODUCTION Methylene blue (MB) has been used in the identification of abnormal parathyroid glands in surgery for hyperparathyroidism. Its efficacy and safety profile have been questioned recently and this study sought to demonstrate such aspects in a unit where its use is routine. METHODS Prospective data collected over six years in a single surgeon's practice were interrogated to identify factors affecting MB staining, side effects suffered and unusual cases where the dye was invaluable in locating the diseased gland. RESULTS A total of 98 patients underwent MB infusion. Of these, 77 cases (78.6%) stained positively with MB and 21 (21.4%) did not. Six patients suffered side effects but there were no cases of neurotoxicity. No positive predictive factors of dye uptake were found. MB was particularly useful in cases of intrathyroidal and ectopic glands as well as improving efficiency in both targeted and open parathyroidectomy. CONCLUSIONS This series shows that when used correctly, MB is efficacious in locating diseased parathyroid glands, with similar sensitivity rates to preoperative ultrasonography and radionucleotide imaging. Adverse effects were much lower than published previously, which may be attributed to the low dose of MB used (3.5mg/kg).

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“…To minimize parathyroid injury, many surgical techniques have been developed and a variety of techniques have been used such as intraoperative carbon nanoparticles injections, methylene blue infusion, technetium-99m-sestamibi localization using a hand-held gamma probe, and optical coherence tomography (24)(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check?

Kim

Bae

et al. 2017

J Endocr Surg

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Purpose: The usefulness of serum intact parathyroid hormone (iPTH) levels for predicting hypocalcemia after total thyroidectomy is well established. This retrospective cohort study aimed to identify the best time iPTH levels should be checked, and determine the postoperative day 1 iPTH level that most safely predict the development of permanent hypoparathyroidism after total thyroidectomy. Methods: All consecutive patients who underwent total thyroidectomy in 2013-2015 were identified, retrospectively. iPTH was measured at 2 hours after thyroidectomy, and on postoperative days 1 and 2, and 12 months after surgery. Results: In total, 730 patients were included. Their iPTH levels on postoperative day 2 correlated better with postoperative day 1 levels (Pearson's r=0.915) than with iPTH levels at 2 hours after total thyroidectomy (r=0.786). Fourteen patients had normal iPTH levels at 2 hours after thyroidectomy but abnormal levels on postoperative days 1 and 2. On the other hand, 38 patients had abnormal iPTH levels at 2 hours after thyroidectomy but normal values on postoperative days 1 and 2. Receiver operating characteristic analysis showed that the iPTH value of 3.05 pg/mL best predicted permanent hypoparathyroidism (sensitivity, 92.9%; specificity, 99.7%). The safe cutoff value was 9.65 pg/mL (sensitivity, 70.9%; specificity, 100%). Conclusion: A single measurement of iPTH on postoperative day 1 predicted patients at risk of transient hypocalcemia more accurately than measurements at 2 hours after surgery, and thus, can serve widely as a predictor of permanent hypoparathyroidism.

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Rapid Intraoperative Localization of Parathyroid Glands Utilizing Methylene Blue Infusion

Cited by 55 publications

References 19 publications

Intraoperative adjuncts in surgery for primary hyperparathyroidism

Intraoperative adjuncts in surgery for primary hyperparathyroidism

The value and role of low dose methylene blue in the surgical management of hyperparathyroidism

Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check?

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