Objectives: To evaluate surgical and biochemical outcome of local methylene blue (TTMB)
injection during subcapsular thyroidectomy in preservation of parathyroid glands.
Patients and Methods: the study include 88 patients divided into two groups. The study
GP include 44 patients assigned for TT-MB and control GP include 44 patients that undergo
CTT. All patients underwent clinical and radiological workup and estimation of serum parathyroid
hormone (PTH) and serum total and ionized calcium (Ca). 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: included frequency of para-thyroid gland (PTG) localization, frequency
and extent of hypo-parathyroidism (HPT) as judged by estimated serum PTH on 1st and
6th postoperative day (POD1 & POD6) in relation to preoperative level and the frequency
and extent of disturbed serum calcium levels.
The outcomes were compared versus outcome of the control group of patients had TT
without the use of MB.
Results: Dissection was easy in 38 cases (86.36%), more difficult in 6 cases (13.63%).
One study and 5 control patients had HPT on POD6 and no study patient, while two
control patients continued suffering hypoparathyroidism 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 of
decreased serum PTH, its extent was minimal and only 1 patient developed transient HPT. |
