Microwave Ablation for Patients Who Refuse Surgery or a Bad Risk for Primary Hyperparathyroidism

Microwave Ablation for Patients Who Refuse Surgery or a Bad Risk for Primary Hyperparathyroidism

Microwave Ablation for Patients Who Refuse Surgery or a Bad Risk for Primary Hyperparathyroidism

Microwave Ablation for Patients Who Refuse Surgery or a Bad Risk for Primary Hyperparathyroidism

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Parathyroid adenoma on US imaging

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Parathyroid scan with delayed image showing the adenoma

Journal of Vascular and Interventional Radiology
Volume 27, Issue 6, June 2016, Pages 867–875
US-Guided Percutaneous Microwave Ablation for Primary Hyperparathyroidism with Parathyroid Nodules: Feasibility and Safety Study

Can Liu et al

To test the feasibility, safety, and efficacy of microwave (MW) ablation for primary hyperparathyroidism (pHPT) in patients who are unsuited or unwilling to undergo surgery.

15 patients were followed up for more than 1 year, with an average duration of 32.8 months ± 17.9. Eleven patients underwent successful ablation in a single session, and two patients with bilateral disease and two patients with residual disease were treated with two sessions each. The rate of complete nodule disappearance was 17.6%. Nodule volume and serum parathyroid hormone (PTH) and calcium levels were significantly lower at the last follow-up than before treatment (volume, 0.39 cm3 ± 0.69 vs 2.62 cm3 ± 3.32; PTH, 54.5 pg/mL ± 24.1 vs 592.5 pg/mL ± 579.1; and calcium, 2.32 mmol/L ± 0.12 vs 2.93 mmol/L ± 0.47; P < .01). Treatment was well tolerated. Minor complications included transient voice change in one patient.

Conclusions

MW ablation is a safe and effective technique for the treatment of pHPT. It is a good alternative for patients who do not meet surgery criteria or decline surgery.

Comment: Similar to other ablation systems there is still no replacing surgery as it cures the patient while ablations  are only a temporizing in difficult cases refusing surgery.The disease will recur.

Richard Guttler MD,FACE,ECNU

www.thyroid.com

Drawing  of MWA system

2 Comments
  • Johnathon Hawkins February 28, 2018 12:53 pm

    Dr. Gutter,
    My wife is 43 yo and has primary hyperparathyroidism. She underwent an unsuccessful parathyroid surgery which last 12 hrs. After two negative Sestmibi scans I took her to UCSF where they performed a PET-MRI which localized the adenoma. It is 5mm in size and located behind her left clavicle. The endocrine surgeons at UCSF said the only way they could get to the adenoma would be vis median sternotomy. This isn’t something we are comfortable with. IS RFA or selective intravascular embolization a potential option? Thanks for your time.

    • Dr Guttler March 1, 2018 6:57 am

      Hi Johnathon,

      Be aware that a 5 mm PA is very small. I will do a detailed parathyroid complete neck US as there are PAs found anywhere in the neck.
      US is the best way to locate the real adenoma and prove the 5 mm is a red herring.

      Yes, It is possible to ablate that PA with either ethanol or RFA. You need to bring her to see me for an evaluation to see if these are possible before you open the chest.
      A one day visit is needed to evaluate her for ablation .
      The evaluation fee is $2500.This includes PTH needle washout to prove that is the real source of the hyperparathyroidism.
      She needs to send me any studies done including prior surgery or biopsy path reports.

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