1Furkan Ertürk URFALI,2Sezgin ZEREN, 3Sezgin ZEREN, 1Güven Barış CANSU, 3Mustafa Cem ALGIN, 1Mustafa Cem ALGIN
Although parathyroidectomy operations are effective treatments in patients with primary hyperparathyroidism, the use of local ablation treatments in this area has recently gained momentum due to post-procedure bleeding, hoarseness caused by nerve damage, and long recovery periods. We aimed to share the preliminary results of ultrasound-guided microwave ablation (MWA) and our experience about of the procedure.
Material(s) and Method(s):
Between March 2021 and February 2022, a total of 13 patients underwent US-guided microwave ablation therapy. MWA was applied to 2 patients because they could not get approval for general anesthesia and one patient had residual adenoma after the surgical procedure. Before the procedure, age, gender, blood parameters (calcium (Ca), parathyroid hormone(PTH)), localization of parathyroid adenoma, volume, shear-wave elastographic (SWE) values obtained from the archives. After the procedure, the control PTH was studied from the blood samples taken at the 2nd hour. Blood Ca level and USG evaluations were performed at the clinic controls of the patients at the 1st month after the procedure.
The mean age of the patients was 58.1 ± 9.2 (47-73). Of the patients, 4 (31%) were male and 9 (69%) were female. Of the parathyroid adenomas, 6 (46%) were on the right and 7 (54%) were on the left. The adenoma volume was measured as 1.41 ± 0.55 (0.38-2.77)cm3 and the SWE klioPascal (kPa) value was 4.77 ± 0.21 (4.51-5.12) before the procedure. Before the procedure, PTH was measured as 217.92 ± 157.37(125-713) ng/L, calcium 11.89 ±0.51 (11.3-13.2)mg/dL. No major or minor complications such as hoarseness or bleeding were observed in any of our patients after the MWA procedure. In the blood tests taken from the patients at the 2nd hour after the procedure, PTH levels of all patients were measured within the normal range. Post-procedure, adenoma volume was measured as 1.02 ±0.42 (0.22-1.63)cm3, PTH 20.69 ±7.86(10-34) ng/L and calcium 9.5 ±0.41(9-10.1) mg/dL. Parathyroid adenoma size decreased by 28% (p<0.001) on average after MWA. PTH levels decreased over 90% (p<0.001) and calcium levels decreased 20% (p<0.001).
US-guided MWA is an effective treatment alternative to parathyroidectomy in the treatment of parathyroid adenoma, with its advantages such as being performed without general anesthesia and low complication risk. Our preliminary results showed that MWA treatment resulted in an effective improvement in blood PTH, Ca levels and adenoma size.