Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Endocrine
Published in: Endocrine 3/2024

19-09-2023 | Parathyroidectomy | Original Article

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

Authors: Tingting Jiang, Erya Deng, Huihui Chai, Ning Weng, Hongfeng He, Zhengxian Zhang, Dandan li, Wenwen Yue, Chengzhong Peng, Hui-Xiong Xu

Published in: Endocrine | Issue 3/2024

Login to get access

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.
Literature
1.
W.L. Lau, Y. Obi, K. Kalantar-Zadeh, Parathyroidectomy in the management of secondary hyperparathyroidism. Clin. J. Am. Soc. Nephrol. 13(6), 952–961 (2018)PubMedPubMedCentralCrossRef
2.
J.B. Cannata-Andía, J.L. Fernández-Martín, C. Zoccali, G.M. London, F. Locatelli, M. Ketteler, A. Ferreira, A. Covic, J. Floege, J.L. Górriz et al. Current management of secondary hyperparathyroidism: a multicenter observational study (COSMOS). J. Nephrol. 21(3), 290–298 (2008)PubMed
3.
X. Kong, L. Zhang, L. Zhang, N. Chen, Y. Gu, X. Yu, W. Liu, J. Chen, L. Peng, W. Yuan et al. Mineral and bone disorder in Chinese dialysis patients: a multicenter study. BMC Nephrol. 13, 116 (2012)PubMedPubMedCentralCrossRef
4.
E. Zitt, M. Rix, P. Ureña Torres, D. Fouque, S.H. Jacobson, F. Pétavy, B. Dehmel, M. Ryba, Effectiveness of cinacalcet in patients with recurrent/persistent secondary hyperparathyroidism following parathyroidectomy: results of the ECHO study. Nephrol. Dial. Transpl. 26(6), 1956–1961 (2011)CrossRef
5.
R. Schneider, E.P. Slater, E. Karakas, D.K. Bartsch, K. Schlosser, Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J. Surg. 36(2), 318–326 (2012)PubMedCrossRef
6.
W.J. Johnson, J.T. McCarthy, J.A. van Heerden, S. Sterioff, C.S. Grant, P.C. Kao, Results of subtotal parathyroidectomy in hemodialysis patients. Am. J. Med. 84(1), 23–32 (1988)PubMedCrossRef
7.
E.R. Gagné, P. Ureña, S. Leite-Silva, J. Zingraff, A. Chevalier, E. Sarfati, C. Dubost, T.B. Drüeke, Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J. Am. Soc. Nephrology: JASN, 3(4), 1008–1017 (1992)CrossRef
8.
G. Gasparri, M. Camandona, G.C. Abbona, M. Papotti, A. Jeantet, E. Radice, B. Mullineris, M. Dei Poli, Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann. Surg. 233(1), 65–69 (2001)PubMedPubMedCentralCrossRef
9.
A. Simental, R.L. Ferris, Reoperative parathyroidectomy. Otolaryngolog. Clin. North Am. 41(6), 1269–1274 (2008)CrossRef
10.
L. Yan, X. Li, Y. Li, J. Xiao, M. Zhang, Y. Luo, Comparison of ultrasound-guided radiofrequency ablation versus thyroid lobectomy for T1bN0M0 papillary thyroid carcinoma. Eur. Radio. 33(1), 730–740 (2023)CrossRef
11.
F. Izzo, V. Granata, R. Grassi, R. Fusco, R. Palaia, P. Delrio, G. Carrafiello, D. Azoulay, A. Petrillo, S.A. Curley, Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist 24(10), e990–e1005 (2019)PubMedPubMedCentralCrossRef
12.
F.G. Pareja, P.P. Naranjo, M.D.R. Olmedilla, A.C. Pena, Radiofrequency ablation for thyroid and parathyroid disease. Radiologia 64(4), 383–392 (2022)CrossRef
13.
Y. Wei, C.-Z. Peng, S.-R. Wang, J.-F. He, L.-L. Peng, Z.-L. Zhao, X.-J. Cao, Y. Li, M.-A. Yu, Effectiveness and safety of thermal ablation in the treatment of primary hyperparathyroidism: a multicenter study. J. Clin. Endocrinol. Metab. 106(9), 2707–2717 (2021)PubMedPubMedCentralCrossRef
14.
F.Y. Liu, Y. Liu, C.Z. Peng, M.G. Yu, S.S. Wu, L.X. Qian, Z.Y. Han, J. Yu, H.H. Chai, P. Liang, Ultrasound-guided microwave and radiofrequency ablation for primary hyperparathyroidism: a prospective, multicenter study. Eur. Radiol. 32(11), 7743–7754 (2022)PubMedCrossRef
15.
M. Ren, D. Zheng, J. Wu, Y. Liu, C. Peng, W. Shen, B. Lin, Efficacy and safety of radiofrequency ablation versus parathyroidectomy for secondary hyperparathyroidism in dialysis patients: a single-center retrospective study. Sci. Rep. 12(1), 10289 (2022)ADSPubMedPubMedCentralCrossRef
16.
C.C. Chen, H.L. Chen, P.L. Chiang, S.D. Luo, Y.H. Chang, W.C. Chen, C.K. Wang, A.N. Lin, Y.S. Chen, S.Y. Chi et al. Efficacy and safety of radiofrequency ablation for primary and secondary hyperparathyroidism with or without previous parathyroidectomy: a retrospective study. Int. J. Hyperth. : Off. J. Eur. Soc. Hyperther. Oncol., North Am. Hyperth. Group 39(1), 907–917 (2022)CrossRef
17.
M.-A. Yu, L. Yao, L. Zhang, L. Peng, L. Zhuo, Y. Zhang, W. Li, M.-D. Lv, Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: a retrospective pilot study. Int. J. Hyperth. 32(2), 180–186 (2016)CrossRef
18.
H.H. Chen, C.J. Lin, C.J. Wu, C.T. Lai, J. Lin, S.P. Cheng, T.L. Yang, Chemical ablation of recurrent and persistent secondary hyperparathyroidism after subtotal parathyroidectomy. Ann. Surg. 253(4), 786–790 (2011)PubMedCrossRef
19.
L. Zhuo, L.L. Peng, Y.M. Zhang, Z.H. Xu, G.M. Zou, X. Wang, W.G. Li, M.D. Lu, M.A. Yu, US-guided microwave ablation of hyperplastic parathyroid glands: safety and efficacy in patients with end-stage renal disease-a pilot study. Radiology 282(2), 576–584 (2017)PubMedCrossRef
20.
Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group, KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int. Suppl. Kidney Int. Suppl. 7(1), 1–59 (2017)
21.
D. Sacks, T.E. McClenny, J.F. Cardella, C.A. Lewis, Society of interventional radiology clinical practice guidelines. J. Vasc. Inter. Radio. 14(9 Pt 2), S199–202 (2003)CrossRef
22.
C. Kim, J.H. Lee, Y.J. Choi, W.B. Kim, T.Y. Sung, J.H. Baek, Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers. Eur. Radio. 27(8), 3128–3137 (2017)CrossRef
23.
Z. Zeng, C.Z. Peng, J.B. Liu, Y.W. Li, H.F. He, Q.H. Hu, B. Lin, X.G. Shen, Efficacy of ultrasound-guided radiofrequency ablation of parathyroid hyperplasia: single session vs. two-session for effect on hypocalcemia. Sci. Rep. 10(1), 6206 (2020)ADSPubMedPubMedCentralCrossRef
24.
H.R. Choi, M.A. Aboueisha, A.S. Attia, M. Omar, E.L. A, E.A. Toraih, M. Shama, W.Y. Chung, J.J. Jeong, E. Kandil, Outcomes of subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for tertiary hyperparathyroidism: multi-institutional study. Ann. Surg. 274(4), 674–679 (2021)PubMedCrossRef
25.
H.I. Lu, F.F. Chou, S.Y. Chi, S.C. Huang, Thoracoscopic removal of hypertrophic mediastinal parathyroid glands in recurrent secondary hyperparathyroidism. World J. Surg. 39(2), 400–409 (2015)PubMedCrossRef
26.
L. Zhu, F. Cheng, X. Zhu, B. Zhou, Y. Xu, Y. Wu, C. Shao, Safety and effectiveness of reoperation for persistent or recurrent drug refractory secondary hyperparathyroidism. Gland Surg. 9(2), 401–408 (2020)PubMedPubMedCentralCrossRef
27.
L. Alvarado, N. Sharma, R. Lerma, A. Dwivedi, A. Ahmad, A. Hechanova, F. Payan-Schober, A. Nwosu, E. Alkhalili, Parathyroidectomy versus cinacalcet for the treatment of secondary hyperparathyroidism in hemodialysis patients. World J. Surg. 46(4), 813–819 (2022)PubMedPubMedCentralCrossRef
28.
S. Yumita, Intervention for recurrent secondary hyperparathyroidism from a residual parathyroid gland. Nephrol. Dial. Transpl. 18, iii62–64 (2003)CrossRef
29.
R. Eriguchi, J. Umakoshi, Y. Tominaga, Y. Sato, Successful treatment of inoperable recurrent secondary hyperparathyroidism with cinacalcet HCl. NDT 1(4), 218–220 (2008)
30.
W.G. Douthat, G. Cardozo, G. Garay, S. Orozco, C. Chiurchiu, J. de la Fuente, J. de Arteaga, P.U. Massari, Use of percutaneous ethanol injection therapy for recurrent secondary hyperparathyroidism after subtotal parathyroidectomy. Int J. Nephrol. 2011, 246734 (2011)PubMedPubMedCentralCrossRef
31.
G.M. Chertow, G.A. Block, R. Correa-Rotter, T.B. Drüeke, J. Floege, W.G. Goodman, C.A. Herzog, Y. Kubo, G.M. London, K.W. Mahaffey et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N. Engl. J. Med. 367(26), 2482–2494 (2012)PubMedCrossRef
32.
E. Zitt, M. Rix, P. Urena Torres, D. Fouque, S.H. Jacobson, F. Petavy, B. Dehmel, M. Ryba, Effectiveness of cinacalcet in patients with recurrent/persistent secondary hyperparathyroidism following parathyroidectomy: results of the ECHO study. Nephrol. Dial. Transpl. 26(6), 1956–1961 (2011)CrossRef
33.
R. Kovatcheva, J. Vlahov, J. Stoinov, F. Lacoste, C. Ortuno, K. Zaletel, US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism. Eur. Radio. 24(9), 2052–2058 (2014)CrossRef
34.
N. Singh Ospina, G.B. Thompson, R.A. Lee, C.C. Reading, W.F. Young Jr, Safety and efficacy of percutaneous parathyroid ethanol ablation in patients with recurrent primary hyperparathyroidism and multiple endocrine neoplasia type 1. J. Clin. Endocrinol. Metab. 100(1), E87–90 (2015)PubMedCrossRef
35.
P. Li Zhuo, M. Li-li Peng, P. Yu-mei Zhang, M. Zhi-hong Xu, M. Gu-ming Zou, M. Xin Wang, P. Wen-ge Li, P. Ming-de Lu, P. Ming-an Yu, Us-guided Microwave ablation of hyperplastic parathyroid glands: safety and efficacy in patients with end-stage renal disease—a pilot study. Radiology 282(2), 576–584 (2016)PubMedCrossRef
36.
F. Koiwa, T. Kakuta, R. Tanaka, S. Yumita, Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in haemodialysis patients with secondary hyperparathyroidism. Nephrol., Dialysis, Transplant. : Off. Publ. Eur. Dialysis Transpl. Assoc. - Eur. Ren. Assoc. 22(2), 522–528 (2007)CrossRef
37.
M.A. Yu, L. Yao, L. Zhang, L. Peng, L. Zhuo, Y. Zhang, W. Li, M.D. Lv, Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: a retrospective pilot study. Int. J. Hyperth. : Off. J. Eur. Soc. Hyperth. Oncol., North Am. Hyperth. Group 32(2), 180–186 (2016)CrossRef
38.
L. Appelbaum, S.N. Goldberg, T. Ierace, G. Mauri, L. Solbiati, US-guided laser treatment of parathyroid adenomas. Int. J. Hyperth. : Off. J. Eur. Soc. Hyperth. Oncol., North Am. Hyperth. Group 37(1), 366–372 (2020)CrossRef
39.
G. Adda, A. Scillitani, P. Epaminonda, S. Di Lembo, F. Motta, P. Cecconi, G. Vecchi, M. Arosio, I. Chiodini, Ultrasound-guided laser thermal ablation for parathyroid adenomas: analysis of three cases with a three-year follow-up. Horm. Res. 65(5), 231–234 (2006)PubMed
40.
N.E. Cusano, J.A. Lee, R.F. Wetmore, E. Kazam, J.P. Bilezikian, Primary hyperparathyroidism after laser therapy to the larynx. Endocr. Pr. 19(5), 888–890 (2013)CrossRef
41.
C.E. Ambrosini, L. Cianferotti, A. Picone, L. Torregrossa, G. Segnini, G. Frustaci, F. Cetani, F. Basolo, C. Marcocci, P. Miccoli, High-intensity focused ultrasound as an alternative to the surgical approach in primary hyperparathyroidism: a preliminary experience. J. Endocrinol. Investig. 34(9), 655–659 (2011)CrossRef
42.
R.D. Kovatcheva, J.D. Vlahov, J.I. Stoinov, G.G. Kirilov, S.G. Krivoshiev, F. Arnaud, C. Ortuno, T.B. Drüeke, High-intensity focussed ultrasound (HIFU) treatment in uraemic secondary hyperparathyroidism. Nephrol., Dialysis, Transplant. : Off. Publ. Eur. Dialysis Transpl. Assoc. - Eur. Ren. Assoc. 27(1), 76–80 (2012)CrossRef
43.
L. Zhuo, L. Zhang, L.L. Peng, Y. Yang, H.T. Lu, D.P. Chen, W.G. Li, M.A. Yu, Microwave ablation of hyperplastic parathyroid glands is a treatment option for end-stage renal disease patients ineligible for surgical resection. Int. J. Hyperth. : Off. J. Eur. Soc. Hyperthermic Oncol., North Am. Hyperth. Group 36(1), 29–35 (2019)CrossRef
44.
G. Wang, S. Liu, X. Liu, L. Qian, Z. Diao, W. Liu, Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis. Int J. Hyperthermia: 33(8), 946–952 (2017)PubMed
45.
I. Nawrot, W. Chudzinski, T. Ciacka, M. Barczynski, J. Szmidt, Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci. Monit. 20, 1604–1612 (2014)PubMedPubMedCentralCrossRef
46.
W. Ni, Y. Yuan, X. Chu, G. Chen, X. Han, J. Li, X. Wu, J. Wang, C. Liu, S. Xu, Bone turnover markers in response to ultrasound-guided microwave ablation for primary hyperparathyroidism. Front. Endocrinol. 12, 782050 (2021)CrossRef
47.
Y. Wei, C.Z. Peng, S.R. Wang, J.F. He, L.L. Peng, Z.L. Zhao, X.J. Cao, Y. Li, M.A. Yu, Effectiveness and safety of thermal ablation in the treatment of primary hyperparathyroidism: a multicenter study. J. Clin. Endocrinol. Metab. 106(9), 2707–2717 (2021)PubMedPubMedCentralCrossRef
48.
S.J. Bo, X.F. Xu, C.Y. Qiu, T.T. Wang, Y.D. Ning, H.Y. Li, Re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism after parathyroidectomy with autotransplantation. Lin. Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 32(2), 142–147 (2018)PubMed
Metadata
Title
Radiofrequency ablation for patients with recurrent or persistent secondary hyperparathyroidism after parathyroidectomy: initial experience
Authors
Tingting Jiang
Erya Deng
Huihui Chai
Ning Weng
Hongfeng He
Zhengxian Zhang
Dandan li
Wenwen Yue
Chengzhong Peng
Hui-Xiong Xu
Publication date
19-09-2023
Publisher
Springer US
Published in
Endocrine / Issue 3/2024
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-023-03513-5

Other articles of this Issue 3/2024

Endocrine 3/2024 Go to the issue

Meta- Analysis

The effect of semaglutide on blood pressure in patients with type-2 diabetes: a systematic review and meta-analysis

Original Article

Association of adipocyte size and SREBP-1c in visceral and subcutaneous adipose tissue in non-obese type 2 diabetes mellitus

Original Article

Alteration of the immunophenotype and cytokine profiles in patients affected by neuroendocrine neoplasms

Review

Epidemiology and diagnosis of primary aldosteronism. What have we learned from the SPAIN-ALDO registry?

Original Article

Contrast CT radiomic features add value to prediction of prognosis in adrenal cortical carcinoma

Original Article

The endocrine disruptor cadmium modulates the androgen–estrogen receptors ratio and induces inflammatory cytokines in luminal (A) cell models of breast cancer
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits