Minimally Invasive Treatment for Benign Parathyroid Lesions: Treatment Efficacy and Safety Based on Nodule Characteristics

Abstract

This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided minimally invasive treatment in patients with parathyroid lesions. Materials and Methods: This study included 27 patients who had undergone US-guided radiofrequency ablation (RFA) or ethanol ablation (EA) for parathyroid lesions between January 2010 and 2018. RFA was performed in 19 patients with primary hyperparathyroidism (PHPT, n = 11) or secondary hyperparathyroidism (SHPT, n = 8), and EA was performed in eight patients with symptomatic nonfunctioning parathyroid cysts (SNPCs). Nodule size, volume, serum parathyroid hormone (PTH) and calcium levels were recorded before and after treatment. Complications were evaluated during and after treatment. Results: In patients with PHPT, significant reductions in size and volume were noted after RFA at 6-and 12-month follow-up (all, p < 0.05). Seven nodules nearly completely disappeared (residual volume < 0.1 mL); serum PTH and calcium levels were reduced to normal ranges (7/11, 63.6%). Four patients experienced partial reductions of serum PTH and calcium levels (4/11, 36.4%). In patients with SHPT, three experienced therapeutic response of serum PTH (3/8, 37.5%), while five showed persistent hyperparathyroidism (5/8, 62.5%) within 6 months after RFA. In patients with SNPCs, EA resulted in significant reductions in cyst size and volume (all, p < 0.05) at the last follow-up. A total of four complications (two transient hypocalcemia [RFA], one permanent [RFA], and one transient [EA] hoarseness) were observed. Conclusion: Minimally invasive treatments, such as RFA and EA, may serve as therapeutic alternatives for patients with PHPT or SNPCs; they may have limited usefulness in patients with SHPT.

A study on the causes of operative failures after microwave ablation for primary hyperparathyroidism

“…Partial remission of hyperparathyroidism caused by incomplete ablation had also been reported in previous studies [10,20]. Based on the three patients with operative failure due to incomplete ablation in the present study, our recommendations are summarized as follows: (i) a complete ablation should contain both hypoechoic hyperplastic nodules and normal parathyroid tissue, which often appear hyperechoic on US, especially after the injection of the isolation solution (Fig.…”

Radiofrequency Ablation of Parathyroid Adenoma: A Novel Treatment Option for Primary Hyperparathyroidism

“…20 Twelve patients had decreases in the serum calcium and iPTH levels after RFA, and 19 had complete normalization of the serum calcium and iPTH levels. 5,15,16 Only 3 patients had minor complications. RFA in all the cases was performed under local anesthesia.…”

“…Nine reports were identified that described 32 cases of PHPT treated with RFA (Table ). 5,[14][15][16][17][18][19][20][21] In these cases, RFA was performed because of either contraindication to surgery or the patient refusing surgery, and there was limited follow-up. Of note, in 1 case, RFA was performed inadvertently when a parathyroid adenoma was mistaken for a thyroid nodule; this was the only case where there was no improvement in biochemical profile.…”

“…2,4 There are limited data regarding the complications when ablating parathyroid adenomas; however, hypocalcemia and voice hoarseness have been reported. 5 We present the first reported case, to our knowledge, of PHPT treated with RFA in the U.S. Our objective was to demonstrate that RFA is a safe and effective alternative to treat parathyroid adenomas in patients who are not eligible for surgery or those who do not want surgery. This will add to the growing body of literature supporting the use of minimally invasive nonsurgical techniques for the treatment of endocrine disorders.…”

Letter to the Editor Regarding “Minimally Invasive Treatment for Benign Parathyroid Lesions: Treatment Efficacy and Safety Based on Nodule Characteristics”

“…I recently read the article titled “Minimally invasive treatment for benign parathyroid lesions: treatment efficacy and safety based on nodule characteristics” with great interest [ 1 ]. The authors performed radiofrequency ablation (RFA) for primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT), which are solid lesions of the parathyroid glands.…”