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US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism



To investigate the long-term efficacy and safety of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) treatment in patients with primary hyperparathyroidism (PHPT).


In our prospective study, 13 of 72 screened patients with PHPT were eligible for HIFU treatment, which was performed in one or two sessions. Parathyroid adenoma size and function were evaluated at baseline, 1, 3, 6, 9, and 12 months after the final HIFU session.


In 11 females and 2 males, mean age 55.2 ± 12.41 years, the mean applied energy was 15.2 ± 7.7 kJ. Parathyroid size and parathyroid hormone decreased significantly one month after HIFU therapy (p < 0.002 and p < 0.02, respectively). Calcium concentration decreased slowly to reach significant reduction nine months later (p < 0.05). Complete remission was noted in three patients (23 %) after one year, good disease control was achieved in nine (69 %), and procedure was unsuccessful in one patient (8 %). Number of sessions was significantly related to treatment success (p < 0.05). Transitory side effects were impaired vocal cord mobility in three patients (23.1 %), subcutaneous oedema in three patients (23.1 %), and a combination of both in two patients (15.4 %).


HIFU is a promising non-invasive technique for PHPT treatment, which could serve as therapeutic alternative for selected patients.

Key Points

US-guided HIFU is a new non-invasive ablative technique for parathyroid adenomas.

• The method is efficient and ensures good disease control in most patients.

• HIFU is a good alternative for patients not meeting surgery criteria.

• Treatment is well-tolerated with only transient side effects.

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High-intensity focused ultrasound


Primary hyperparathyroidism


Parathyroid hormone


Standard deviation


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The scientific guarantor of this publication is Prof. Sabina Zaharieva, MD, DSc. The authors of this manuscript declare relationships with the following companies: Theraclion. This study has received funding by Theraclion. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in:

Kovatcheva RD, Vlahov JD, Shinkov AD et al (2010) High-intensity focused ultrasound to treat primary hyperparathyroidism: a feasibility study in four patients. Am J Roentgenol 195;830-835.

Methodology: prospective, experimental – interventional, performed at one institution.

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Correspondence to Roussanka Kovatcheva.

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Kovatcheva, R., Vlahov, J., Stoinov, J. et al. US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism. Eur Radiol 24, 2052–2058 (2014).

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  • Parathyroid adenoma
  • Parathyroid hormone
  • Primary hyperparathyroidism
  • Interventional ultrasonography
  • High-intensity focused ultrasound ablation