Background: Thyroid surgeries are commonly operated head and neck surgeries. Significant morbidity is caused by thyroidectomy complications such as recurrent laryngeal nerve (RLN) and parathyroids injuries. Objective: To reduce the risk of complications after thyroidectomy, we employed methylene blue spray to locate the RLNs and parathyroid glands. Patients and method: This was a prospective, randomized, controlled trial of 80 patients with thyroid disease who were eligible for total thyroidectomy. Group 1: patients were managed by traditional thyroidectomy where the RNL and parathyroid glands were identified anatomically. Group 2: Diluted methylene blue spray was used to aid in the identification of the RLN and the parathyroid glands. Results: Both groups had the RLN identified. In group 2 the neve did not take the dye and remained white. At least one of the parathyroid glands could be identified in 35 patients in group 1, while it was identified in 37 patients in group 2. The parathyroid was stained with methylene blue then the dye was washed out in 3 minutes. Neither group had a statistically significant advantage over the other in identifying the parathyroid gland, p-value=0.356. The RLN was identified in all patients of both groups. Conclusion: Methylene blue dye spraying is technically feasible, safe, and effective method for identifying and protecting the RLN and parathyroid glands during thyroidectomy. It can be used as adjunct for the identification of these structures in difficult cases. Minimizing postoperative hypocalcemia requires accurate identification of at least one of the parathyroid glands.