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Radiofrequency ablation for patients with recurrent or persistent secondary hyperparathyroidism after parathyroidectomy: initial experience

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Abstract

Background

Reoperation for recurrent or persistent secondary hyperparathyroidism (SHPT) after parathyroidectomy is challenging due to surgical scars and postoperative adhesions. Therefore, there is an increasing need to develop a new minimally invasive therapy.

Objective

To analyze the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with recurrent or persistent SHPT after parathyroidectomy.

Patients and methods

From March 2013 to January 2022, 20 enlarged parathyroid glands in 10 patients with recurrent or persistent SHPT were treated with US-guided RFA. The levels of serum intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP), as well as clinical symptoms, were compared before and after RFA. The ablation procedure-related complications were also evaluated. The target range for iPTH levels was approximately 2–9 times the upper limit of normal (130–585 pg/mL).

Results

The mean follow-up time was 49.6 ± 34.5 months (range from 6 to101 months). The levels of serum iPTH, Ca, and P decreased significantly one day post-ablation. Six months after RFA, 70% of patients reached the targets for iPTH, and 50% of patients reached targets at the end of follow-up. Two patients underwent repeat ablation at 9 months and 6 years after RFA, respectively, due to persistently elevated iPTH levels, and both had serum iPTH concentrations in the recommended range at the recent follow-up visit. The patients’ clinical symptoms significantly improved after ablation. Major complications after RFA included hoarseness (2/10) and permanent hypoparathyroidism (1/10). Severe hypocalcemia occurred in four patients (4/10) after ablation.

Conclusion:

US-guided percutaneous RFA for recurrent or persistent SHPT is safe, efficacious, and repeatable, and can significantly improve hyperparathyroidism-related symptoms.

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Funding

The study was supported by National Natural Science Foundation of China (Grant No: 81901754). The authors are very grateful to the foundation for its support.

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Author notes

  1. These authors contributed equally: Tingting Jiang, Erya Deng

Authors and Affiliations

  1. Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200072, China

    Tingting Jiang, Erya Deng, Huihui Chai, Dandan li, Wenwen Yue & Chengzhong Peng

  2. Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China

    Tingting Jiang, Erya Deng, Huihui Chai, Dandan li, Wenwen Yue & Chengzhong Peng

  3. Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, 200072, China

    Tingting Jiang, Erya Deng, Huihui Chai, Dandan li, Wenwen Yue & Chengzhong Peng

  4. Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310007, China

    Ning Weng

  5. Department of Ultrasound, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China

    Hongfeng He

  6. Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310007, China

    Zhengxian Zhang

  7. Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, China

    Hui-Xiong Xu

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  1. Tingting Jiang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Tingting Jiang, Erya Deng and Huihui Chai. The first draft of the manuscript was written by Tingting Jiang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Wenwen Yue or Chengzhong Peng.

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The authors declare no competing interests.

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This study was approved by the Human Ethics Committee of the enrolled institutes.

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Written informed consent was obtained from all patients prior to ablation. And the need for individual informed consent was waived because of the retrospective nature of the study.

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Jiang, T., Deng, E., Chai, H. et al. Radiofrequency ablation for patients with recurrent or persistent secondary hyperparathyroidism after parathyroidectomy: initial experience. Endocrine 83, 681–690 (2024). https://doi.org/10.1007/s12020-023-03513-5

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