Objectives
To evaluate surgical and biochemical outcomes of local methylene blue [total thyroidectomy (TT)-MB] injection during subcapsular thyroidectomy in preservation of parathyroid glands (PTGs).
Patients and methods
The study include 88 patients divided into two groups. The study group (GP) included 44 patients assigned to TT-MB and control GP included 44 patients who underwent conventional total thyroidectomy. All patients underwent clinical and radiological workup and estimation of serum parathyroid hormone (PTH) and serum total and ionized calcium. Operative procedure entails injection of 1–3 ml MB (0.8 mg/ml) in thyroid subcapsular layer, and the procedure was repeated till completion of thyroidectomy.
Study outcomes
The study outcomes included frequency of PTG localization, frequency and extent of hypoparathyroidism (HPT) as judged by estimated serum PTH on first and sixth postoperative day (POD1 and POD6) in relation to preoperative level, and the frequency and extent of disturbed serum calcium levels. The outcomes in the cases with TT-MB were compared with the outcomes of the control group patients, who had TT without the use of MB.
Results
Dissection was easy in 38 (86.36%) cases and more difficult in six (13.63%) cases. One study and five control patients had HPT on POD6, and no study patient but two control patients continued experiencing HPT, with significant difference in favor of study group.
Conclusion
Subcapsular MB injection during subcapsular thyroidectomy facilitates safe thyroid dissection sparing PTG with easy successful dissection rate of 86.36%. Despite decreased serum PTH, its extent was minimal, and only one patient developed transient HPT.