Thermal Ablation Versus Parathyroidectomy for Primary Hyperparathyroidism

Thermal Ablation Versus Parathyroidectomy for Primary Hyperparathyroidism: a Multicenter Study

This study is a prospective, multicenter study designed to compare the efficacy and safety of surgical treatment versus ablation therapy (including radiofrequency ablation and microwave ablation) for patients with primary hyperparathyroidism (PHPT). The study will assess the impact of both treatment modalities on serum parathyroid hormone (iPTH) and calcium levels, clinical symptom improvement, bone mineral density enhancement, reduction in the incidence of urinary system stones, and postoperative complication rates. While surgical treatment has been the standard of care for PHPT, offering definitive cure, it carries inherent surgical risks and complications. Ablation therapy, as a minimally invasive approach, presents a novel alternative with reduced trauma and fewer complications. The outcomes of this study will inform clinical decision-making and potentially optimize treatment strategies for patients with PHPT.

Inclusion Criteria:

• Symptomatic patients with primary hyperparathyroidism, such as those with symptoms in any system including the kidneys, bones, gastrointestinal tract, psychoneurological system, or those with atypical symptoms such as muscle weakness, dysfunction, and sleep disorders.

• Asymptomatic PHPT patients with any of the following conditions:

  ① Serum calcium is higher than the upper limit of the normal value by 1 mg/dL (0.25 mmol/L);

  ② There is objective evidence of renal involvement, including asymptomatic kidney stones, nephrocalcinosis, hypercalciuria (24 - hour urinary calcium level > 400 mg/dL) on renal imaging, or impaired renal function (glomerular filtration rate < 60 mL/min);

  ③ There is evidence of osteoporosis (bone mineral density decreased by 2.5 standard deviations at any site) and/or radiographic evidence of fragility fractures.

  ④ Age < 50 years

  ⑤ The patient cannot accept routine follow - up observation.

• Imaging examination shows that at least one parathyroid gland is enlarged.

Exclusion Criteria:

• diagnosis of secondary or tertiary HPT
• severe coagulation disorder
• severe cardiopulmonary insufficiency