Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder caused by excessive secretion of parathyroid hormone (PTH), leading to elevated serum calcium levels. The primary cause is often a benign parathyroid adenoma. The diagnosis should be confirmed through imaging modalities such as ultrasound, SPECT-CT, or 4D-CT, along with serum calcium, PTH levels, and a 24-hour urine calcium test. Current guidelines recommend parathyroidectomy as the standard treatment method for PHPT. However, the application of radiofrequency ablation (RFA) has emerged as a novel and promising treatment option. RFA is a well-established treatment for benign thyroid nodules, and it is a minimally invasive alternative to surgery. This study presents a case of parathyroid adenoma that was successfully cured after two RFA sessions in Russia

A 59-year-old asymptomatic female presented with elevated PTH level of 11.86pmol/L and ionized calcium level of 1.39mmol/L, suggesting PHPT. SPECT-CT localized a 7×4×9 mm left lower parathyroid adenoma in the paraoesophageal region. To confirm the diagnosis, a fine-needle aspiration biopsy (FNAB) with PTH washout was performed after ultrasound and scintigraphy, revealing an extremely high intact PTH (iPTH) level of 2404.0pmol/L in the left lower thyroid gland lesion, strongly indicative of a parathyroid adenoma. Osteopenia was noted in the patient, but abdominal ultrasound revealed no abnormalities. Despite vitamin D3 treatment, lab results remained unchanged. The initial RFA under local anesthesia was failed because the adenoma was proximity to a nerve and tended to move and hide during hydrodissection, making precise targeting hazardous. Its extrathyroidal location, encased by fascia, further hindered targeting. After a week later, a second RFA attempt was made under general anesthesia before planned cervicotomy. This approach allowed for muscle relaxation, which stabilized the adenoma, minimizing displacement during hydrodissection. Using an 18G RFA needle (STARmed, Korea), the hypoechoic nodule was treated with a moving-shot technique (15–25W) [FIG 1]. The RFA was complete when hyperechoic microbubbles fully surrounded the nodule. Each shot took 5-10 second, and the entire RFA procedure took approximately 1 minutes.

The patient has shown good results of RFA with no complications.

RFA presents an effective alternative to parathyroidectomy for the treatment of PHPT. However, ongoing research is needed to optimize its role in clinical practice.