World Journal of Surgery

, Volume 38, Issue 1, pp 88–91

Ultrasound-Guided Methylene Blue Dye Injection for Parathyroid Localization in the Reoperative Neck

  • Leah Candell
  • Michael J. Campbell
  • Wen T. Shen
  • Jessica E. Gosnell
  • Orlo H. Clark
  • Quan-Yang Duh



The goal of this study was to review a single institution’s experience using intraoperative ultrasound-guided (ioUSG) methylene blue dye injection for the localization and removal of enlarged parathyroid glands in patients with primary hyperparathyroidism and a history of previous neck surgery.


We performed a retrospective review of nine consecutive patients who underwent reoperative parathyroidectomy using ioUSG methylene blue dye injection.


All patients had successful resolution of their hyperparathyroidism, with at least a 50 % decrease in intraoperative parathyroid hormone level after resection. One patient had transient recurrent laryngeal nerve paresis. There were no permanent recurrent laryngeal nerve injuries or cases of permanent hypoparathyroidism.


Blue dye injection is a safe and effective method of localizing diseased parathyroid glands in the reoperative neck.


  1. 1.
    Grant CS, van Heerden JA, Charboneau JW, James EM, Reading CC (1986) Clinical management of persistent and/or recurrent primary hyperparathyroidism. World J Surg 10:555–565. doi:10.1007/BF01655524 PubMedCrossRefGoogle Scholar
  2. 2.
    Akerstrom G, Rudberg C, Grimelius L, Johansson H, Lundstrom B, Rastad J (1992) Causes of failed primary exploration and technical aspects of re-operation in primary hyperparathyroidism. World J Surg 16:565–568. doi:10.1007/BF02067321 Google Scholar
  3. 3.
    Jaskowiak N, Norton JA, Alexander HR, Doppman JL, Shawker T, Skarulis M, Marx S, Spiegel A, Fraker DL (1996) A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg 224:308–321PubMedCrossRefGoogle Scholar
  4. 4.
    Wadström C, Zedenius J, Guinea A, Reeve TS, Delbridge L (1998) Re-operative surgery for recurrent or persistent primary hyperparathyroidism. Aust N Z J Surg 68:103–107PubMedCrossRefGoogle Scholar
  5. 5.
    Silver C, Velez F (1992) Parathyroid re-exploration. Am J Surg 164:606–609PubMedCrossRefGoogle Scholar
  6. 6.
    Shen W, Duren M, Morita E, Higgens C, Duh Q-Y, Siperstein AE, Clark OH (1996) Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 131:861–869PubMedCrossRefGoogle Scholar
  7. 7.
    Caron NR, Sturgeon C, Clark OH (2004) Persistent and recurrent hyperparathyroidism. Curr Treat Options Oncol 5(4):335–345PubMedCrossRefGoogle Scholar
  8. 8.
    Sippel RS, Elaraj DM, Poder L, Duh Q-Y, Kebebew E, Clark OH (2009) Localization of recurrent thyroid cancer using intraoperative ultrasound-guided dye injection. World J Surg 33:434–439. doi:10.1007/s00268-008-9797-0 PubMedCrossRefGoogle Scholar
  9. 9.
    Harari A, Sippel RS, Goldstein R, Aziz S, Shen W, Gosnell J, Duh Q-Y, Clark OH (2012) Successful localization of recurrent thyroid cancer in reoperative neck surgery using ultrasound-guided methylene blue dye injection. J Am Coll Surg 20(10):1–7Google Scholar
  10. 10.
    Perrier ND, Ituarte P, Kikuchi S, Siperstein AE, Duh QY, Clark OH, Gielow R, Hamill T (2000) Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg 24(11):1319–1322. doi:10.1007/s002680010218 PubMedCrossRefGoogle Scholar
  11. 11.
    Dudley NE (1971) Methylene blue for rapid identification of the parathyroids. Br Med J 3:680–681PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Gordon DL, Airan MC, Thomas W, Seidman LH (1975) Parathyroid identification by methylene blue infusion. Br J Surg 62:747–749PubMedCrossRefGoogle Scholar
  13. 13.
    Baumbach CP, Reeve TS (1978) Parathyroid identification by methylene blue infusion. Aust N Z J Surg 48:314–317CrossRefGoogle Scholar
  14. 14.
    Lavelle MA (1980) Parathyroid adenoma stained with methylene blue. R Soc Med 73:462–463Google Scholar
  15. 15.
    Cox RJ, Moore DB, Wolfman EF Jr (1979) Localization of the parathyroid glands by intraoperative methylene blue staining. Surg Gynecol Obstet 148:769–770PubMedGoogle Scholar
  16. 16.
    Wheeler MH, Wade JS (1982) Intraoperative identification of parathyroid glands: appraisal of methylene blue staining. Am J Surg 143:713–716PubMedCrossRefGoogle Scholar
  17. 17.
    Sherlock DJ, Holl-Allen RT (1984) Intravital methylene blue staining of parathyroid glands and tumours. Ann R Coll Surg Engl 66:396–398PubMedCentralPubMedGoogle Scholar
  18. 18.
    Gavilan J, Gavilan C, Tomas MD (1986) Methylene blue infusion for intraoperative identification of the parathyroid glands. Laryngscope 96:1389–1390Google Scholar
  19. 19.
    Kobayashi S, Miyakawa M, Sugenoya A, Senga O, Kaneko G, Yokozawa T, Kasuga Y, Masuda H, Chang YT, Iida F (1988) An evaluation of the intraoperative staining technique using methylene blue for the detection of hyperplastic parathyroid glands. Jpn J Surg 18:729–731PubMedCrossRefGoogle Scholar
  20. 20.
    Derom A, Wallaert P, Janzing H, Van den Brande F, Derom F (1994) Intraoperative identification of parathyroids by means of methylene blue. Acta Chir Belg 94:97–100PubMedGoogle Scholar
  21. 21.
    Devine RM, van Heerden JA, Grant CS, Muir JJ (1983) The role of methylene blue infusion in the management of persistent or recurrent hyperparathyroidism. Surgery 94:916–918PubMedGoogle Scholar
  22. 22.
    Patel HP, Chadwick DR, Harrison BJ, Balasubramanian SP (2012) Systematic review of intravenous methylene blue in parathyroid surgery. Br J Surg 99:1345–1352PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Leah Candell
    • 1
  • Michael J. Campbell
    • 2
  • Wen T. Shen
    • 3
  • Jessica E. Gosnell
    • 3
  • Orlo H. Clark
    • 3
  • Quan-Yang Duh
    • 3
  1. 1.General SurgeryUniversity of California, San Francisco-East BayOaklandUSA
  2. 2.Endocrine SurgeryUniversity of California, DavisDavisUSA
  3. 3.Endocrine SurgeryUniversity of California, San FranciscoSan FranciscoUSA

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