No More Surgery/Parathyroid Adenoma 101: Alternative Therapy with Radiofrequency and Ethanol Ablation.

No More Surgery/Parathyroid Adenoma 101: Alternative Therapy with Radiofrequency and Ethanol Ablation.

No More Surgery/Parathyroid Adenoma 101: Alternative Therapy with Radiofrequency and Ethanol Ablation.

No More Surgery/Parathyroid Adenoma PTA 101: Alternative Therapy with Radiofrequency RF and Ethanol Ablation PEI in selected cases.

Dr.Guttler’s comments: Call me for details if you have a PTA. Ask for Alicia.

310-393-8860 or email to thyroid.manager@protonmail.com

 

1. While RF is the first line alternative treatment for PTA, some patients have contraindication to RF. The presence of metal in the patient’s body can be a reason to avoid RF.

2. Use of PEI is then the next alternative to parathyroid surgery.

3.The article below uses RF to treat PTA.

4. Specific techniques have boosted the development of nonsurgical, minimally invasive procedures, such as percutaneous radiofrequency ablation (RFA)  and ethanol ablation under ultrasonographic guidance, which are gaining popularity as a methods of treatment.

Percutaneous sonography-guided radiofrequency ablation in the management of parathyroid adenoma

Shuang-ying Xu et al

 

 

Case 1  the patient underwent RFA for the purpose of decreasing his serum calcium and PTH levels, as well as to reduce the signs and symptoms associated with hyperparathyroidism. Subsequently, a radiofrequency generator (Celonlab ENT system, Celon AG, Germany) with an internal needle electrode was used for ablation of the adenomatous tissue. The radiofrequency needle was inserted into the centre of the parathyroid adenomatous tissue, and an ablation power of 5 W was applied for 12 min.Although there was transient hoarseness after the procedure, the patient spontaneously improved two days post procedure. Pathologic findings confirmed the diagnosis of parathyroid adenoma. 99mTc-sestamibi scintigraphy performed after ablation revealed no abnormal uptake.

Fig. 2 shows the difference in uptake pre- and post procedure. Four days after the procedure, the patient presented with hypocalcaemia (1.84 mmol/L), which was resolved (2.68 mmol/L) within two weeks with the use of calcium replacement therapy. Two months after the procedure, the patient’s serum levels of PTH, calcium and phosphate had normalised, and there was a reduction in his gastrointestinal and bone disease symptoms.

Case 2A 54-year-old man with a ten-year history of type 2 diabetes mellitus and a two-week history of general fatigue and bone pain was admitted to our hospital. He had a markedly elevated PTH level (> 1,900 ng/L) and hypercalcaemia (3.79–4.57 mmol/L). Symptoms at presentation included osteoporosis and nephrolithiasis. Colour Doppler ultrasonography of the neck detected a large hypoechoic mass dorsal to the left inferior pole of the thyroid gland, possibly originating from the parathyroid gland. Subsequent computed tomography (CT) of the neck revealed a large oval mass, measuring 26.78 mm × 22.40 mm × 4.90 mm, in the left parathyroid gland (Fig. 3).The parathyroid adenoma was treated successfully using RFA under ultrasonographic guidance. The ablation power and time were 5 W and 30 min, respectively.  The RFA procedure was well tolerated by the patient.At two months after the procedure, the patient’s serum calcium level remained normal while his serum PTH level continued to decrease, as evidenced by the reduction of symptoms experienced by the patient.

 DISCUSSION
While surgery is curative, its drawbacks include the risks associated with the use of general anaesthesia, the need for long incision, and possible recurrent laryngeal nerve injury and scar formation.
Specific imaging techniques have boosted the development of nonsurgical, minimally invasive procedures such as ethanol ablation, RFA and laser thermal ablation.
Evidence in the form of higher survival rates, better local control, lower recurrence rates and complete radiological tumour response supports RFA as a procedure superior to ethanol ablation.
However as alternative if RF is contraindicated Ethanol PEI can be used.
However, ethanol ablation may require re-injections in order to achieve a complete cure.
This increases the risk of complications such as haemorrhage, transient alcohol intoxication, local pain.
However, long-term monitoring of serum calcium and PTH levels is important in  both RF and PEI
RFA therapy is a reasonably effective method for treating parathyroid adenoma, with favourable cosmetic results and fewer drawbacks as compared to surgical treatment, although it may require long-term follow-up.
RFA may be an optimal alternative to surgery, especially for patients with high surgical risks, contraindications to surgery due to advanced age, acute severe hypercalcaemia or persistent symptomatic hyperparathyroidism metal inserted for other procedures.
In conclusion, the use of ultrasonography-guided percutaneous RFA in the management of parathyroid adenoma is safe and yields a high degree of recovery from hypercalcaemia. As RFA is an effective therapeutic option for the management of parathyroid adenoma.

 

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