Thermal ablation for primary hyperparathyroidism: long-term follow-up results

Area of Science:

• Endocrinology
• Minimally Invasive Procedures
• Oncology

Background:

• Primary hyperparathyroidism (pHPT) is a common endocrine disorder often requiring treatment.
• Surgical parathyroidectomy is the traditional treatment, but minimally invasive options are increasingly explored.
• Radiofrequency ablation (RFA) and microwave ablation (MWA) offer thermal ablation alternatives.

Purpose of the Study:

• To compare the effectiveness and safety of RFA and MWA for pHPT.
• To evaluate biochemical outcomes, cure rates, recurrence, complications, and symptom improvement.
• To identify predictors of recurrence and long-term success.

Main Methods:

• Retrospective analysis of 69 pHPT patients treated with RFA or MWA (2014-2022).
• Assessment of parathyroid hormone (PTH) and serum calcium levels pre- and post-ablation.
• Evaluation of clinical symptoms (bone pain, fatigue, kidney stones) and complication rates.

Main Results:

• Both RFA and MWA significantly reduced PTH and calcium levels (p < 0.01).
• The 6-month cure rate was 81.2% (MWA: 83.3%, RFA: 76.2%; p = 0.57).
• Recurrence occurred in 18.8%, predicted by high pre-ablation PTH (≥176 pg/mL). Significant symptom improvement (bone pain, fatigue) was observed (p < 0.05). Minor complications included transient hoarseness and hemorrhage.

Conclusions:

• RFA and MWA are equally effective and safe for pHPT treatment.
• Comparable cure and recurrence rates, with minimal complications, were observed.
• Elevated pre-ablation PTH is a risk factor for recurrence; early post-ablation PTH predicts long-term outcomes.