Percutaneous Ultrasound-Guided Ablation of Implanted Parathyroid Glands for Recurrent Hyperparathyroidism After Total Parathyroidectomy.

Purpose: Tertiary hyperparathyroidism is a frequent complication of end-stage kidney disease that may require parathyroidectomy when medical therapy fails. Recurrent hyperparathyroidism may occur after total parathyroidectomy with autotransplantation. This study assessed the safety, feasibility, and efficacy of percutaneous ultrasound-guided ablation for implanted parathyroid glands in patients with recurrent disease after total parathyroidectomy with autotransplantation. Materials and Methods: Eleven patients with recurrent hyperparathyroidism following total parathyroidectomy with autotransplantation who underwent percutaneous ultrasound-guided ablation were retrospectively reviewed. Pre- and post-procedure serum intact parathyroid hormone, calcium, phosphate, and alkaline phosphatase levels were extracted from electronic medical records and analyzed. Ablation modalities used in the study included radiofrequency ablation, microwave ablation, and cryoablation. Procedure-related complications were recorded. Patients were followed for 12 months with serial biomarker monitoring. Technical success was defined as ≥80% ablation of implanted parathyroid glands, and clinical success as meeting at least two of the following: (1) >50% intact parathyroid hormone reduction, (2) correction of hypercalcemia, (3) discontinuation of calcimimetic therapy. Results: Technical success was achieved in 10 of 11 (90.9%) patients; one patient had incomplete ablation due to proximity of the gland to the skin. Among technically successful cases, all (100%) achieved clinical success, showing marked decreases in intact parathyroid hormone, normalization of calcium and phosphate, and reduced calcimimetic use. Transient hypocalcemia occurred in six patients, five requiring intravenous calcium replacement. No long-term complications were observed. Conclusions: Percutaneous ultrasound-guided ablation of implanted parathyroid glands is a safe and effective option for managing recurrent hyperparathyroidism, offering a viable alternative to surgery.