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

This study compared the effectiveness and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for primary hyperparathyroidism (pHPT), evaluating biochemical outcomes, cure rates, recurrence, complications, and symptom improvement.

A retrospective analysis included pHPT patients treated with RFA or MWA from January 2014 to November 2022. We assessed parathyroid hormone (PTH) and serum calcium levels pre- and post-ablation, alongside clinical symptoms (bone pain, fatigue, kidney stones). Cure was defined as sustained PTH (12-88 pg/mL) and calcium (2.2-2.65 mmol/L) normalization for ≥ 6 months.

Sixty-nine patients (mean age: 54.5 ± 13.3 years) were analyzed: 48 received MWA, 21 RFA. Both groups showed significant PTH and calcium reductions post-ablation (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% of patients, primarily within 6-12 months. Pre-ablation PTH ≥ 176 pg/mL strongly predicted recurrence (HR: 2.86, p = 0.005). Post-ablation PTH at 10 and 20 min predicted 2-year outcomes. Symptom improvement was notable: 60% of bone pain and 50% of fatigue cases improved significantly (p < 0.05). No new kidney stones were reported. Minor complications included transient hoarseness (54.4%) and minor hemorrhage (10.1%); no major or delayed complications, such as thyroid dysfunction, occurred.

RFA and MWA are equally effective and safe for pHPT, offering comparable cure and recurrence rates, significant symptom relief, and minimal complications. Elevated pre-ablation PTH signals a higher recurrence risk, with early post-ablation PTH predictive of long-term success.

Question What are the long-term efficacy, safety, and clinical benefits of radiofrequency and microwave ablation for primary hyperparathyroidism, particularly regarding cure rates, recurrence risks, and symptom improvement? Findings Radiofrequency and microwave ablation achieved an 81.2% cure rate, significant symptom improvement, with minimal complications; 18.8% recurrence was linked to high baseline PTH. Clinical relevance Thermal ablation offers a minimally invasive, safe alternative to surgery for primary hyperparathyroidism, with high cure rates, low complication risks, and significant symptom relief, suitable for patients unfit for or preferring to avoid surgical intervention.