Parathyroidectomy Versus Thermal Ablation Of Parathyroid Glands In Patients With Hyperparathyroidism: Randomized Controlled Trial

Abstract

Background: Parathyroidectomy is the main treatment option for patients with primary hyperparathyroidism (HPT), while it is the second choice in patients with the secondary type after failed medical treatment. Despite the efficacy of surgery, it could be risky in these patients secondary to the underlying comorbidities (like renal failure). Recently, microwave ablation (MWA) was reported to be a safe and effective minimally invasive option in such cases. However, the outcomes of surgery versus MWA are rarely discussed in the literature. That was the aim of the current study.

Methodology: Twenty patients diagnosed with either primary or secondary HPT were enrolled in our prospective randomized trial, and they were divided into two groups; Group A (open parathyroidectomy) and Group B (ultrasound-guided MWA).

Results: MWA led to a significant decline in procedure time compared to parathyroidectomy. However, it was associated with higher postoperative pain scores. Both groups showed a significant decrease in parathyroid hormone, calcium, and phosphorus levels, but the decline was more prominent in the surgical group. Parathyroidectomy was associated with a higher incidence of postoperative hypocalcemia, while recurrence was significantly higher in the MWA group. In the MWA group, all patients with secondary HPT had postoperative recurrence, whereas all patients with primary HPT had resolution of their state.

Conclusion: Both parathyroidectomy and MWA could yield excellent outcomes in patients with primary HPT. Nonetheless, parathyroidectomy is superior to MWA in patients with secondary HPT, as the latter is associated with a high recurrence rate.