Microwave ablation as a minimally invasive treatment for primary hyperparathyroidism: A case report and literature review.

Primary hyperparathyroidism (PHPT) is commonly caused by a solitary parathyroid adenoma and results in elevated parathyroid hormone (PTH) and calcium levels. While parathyroidectomy remains the gold standard, some patients are unsuitable for surgery due to comorbidities or personal preference. Percutaneous microwave ablation has emerged as a minimally invasive alternative in select cases. Microwave ablation uses thermal energy to induce localized necrosis of hyperfunctioning parathyroid tissue. Recent studies report cure rates exceeding 85%, with lower complication rates and faster recovery compared to surgery. We report a 33-year-old woman with biochemically confirmed PHPT who presented with fatigue, muscle weakness, and hypercalcemia. Despite meeting criteria for surgical intervention, the patient declined operative management. She underwent ultrasound-guided microwave ablation targeting a suspected parathyroid adenoma localized on a PET choline, Tc-99m Sestamibi Scintigraphy and 4D CT. The procedure was well-tolerated without complications. The microwave ablation was performed in October 2022. Postablation monitoring demonstrated normalization of serum calcium and PTH levels, with sustained biochemical remission and resolution of symptoms at follow-up. Over a 3-year follow-up period, she has maintained normocalcemia and normal PTH levels without recurrence of symptoms or need for surgery. Our findings suggest that microwave ablation is a feasible and promising option for managing PHPT in selected patients unwilling or unable to undergo parathyroidectomy, with a successful long-term biochemical response achieved in this patient after surgery was declined. This case adds to the expanding literature on microwave ablation as a viable alternative to surgery, particularly in individuals seeking less invasive treatment. Ongoing research and long-term data are needed to further define its role in clinical practice.