The Utility of Ultrasound-Guided Microwave and Radiofrequency Ablation in Primary and Secondary Hyperparathyroidism:...

Hyperparathyroidism is classified into primary (PHPT), secondary (SHPT) and tertiary types. While parathyroidectomy (PTX) is standard treatment, minimally invasive thermal ablation (TA) methods are increasingly being explored, especially in high-risk surgical patients. The objective of this study is to review the evidence on TA techniques, microwave (MWA) and radiofrequency (RFA), and compare them to surgical techniques in hyperparathyroidism.

A systematic search was conducted through Medline via six major databases up to February 2025. Meta-analysis was performed using R statistical software (version 2024.04.2 Build 764).

Thirteen studies met the inclusion criteria (8 SHPT, 5 PHPT), involving 652 SHPT and 426 PHPT patients. In PHPT, PTX significantly reduced calcium levels mmol/L at 3 mo compared to MWA (MD = 0.06, 95% CI: [0.01, 0.10]) and RFA (MD = 0.09, 95% CI: [0.04, 0.14]); also outperforming TA at 6 mo for calcium levels mmol/L (MD = 0.07, 95% CI: [0.03, 0.11]) and at 3 mo for iPTH pg/mL (MD = 13.49, 95% CI: [6.12, 20.86]). In SHPT, RFA reduced hospital stay (MD = -4.14), TA lowered infection rates (RR = 0.14) and MWA reduced persistent low PTH (OR = 0.02). In PHPT, MWA reduced hypocalcemia (RR = 0.33), and TA shortened operation time (MD = -46.54). No significant differences were found in ALP, phosphorus, hoarseness, bleeding, severe hypocalcemia, paresthesia or recurrence (p > 0.05).

MWA and RFA may serve as alternatives for high-risk patients unsuitable for surgery. PTX remains the preferred option for patients with extensive disease or who are eligible for surgery.