Complications encountered in the treatment of primary and secondary hyperparathyroidism with microwave ablation – a retrospective study

Figures & data

Figure 1. Flow chart shows patient selection criteria. The bold sections are the inclusion criteria of MWA. iPTH: intact PTH; MIBI: technetium 99m (^99mTc) sestamibi.

Table 1. Complications and side effects in 264 patients who underwent MWA of HPT.

Complication or Side Effect	Number (%)			Time of Detection (D)	Time to Recovery (D)
	Total (264)	SHPT (213)	PHPT (51)
Major	5 (1.9)	5 (2.3)	–	1–4	3–180
Aphonia/hoarseness	4 (1.5)	4 (1.9)	–	1–3	3–90
Horner Syndrome	1 (0.4)	1 (0.5)	–	3	180
Minor	27 (10.2)	22 (10.3)	5 (9.8)	1	1–5
Bucking	11 (4.2)	9 (4.2)	2 (3.9)	1	1–7
Hematoma	2 (0.8)	2 (0.9)	–	1	1
Phonasthenia	14 (5.3)	11 (5.2)	3 (5.9)	1	1–7
Side effect
Pain	15 (5.7)	11 (5.2)	4 (7.8)	1	1–3
Numbness	23 (8.7)	15 (7.0)	8 (15.7)	1–3	1–30
Hypoparathyroidism	14 (5.3)	5 (2.3)	9 (17.6)	1–7	3–14
Hypocalcemia	84 (31.8)	80 (37.6)	4 (7.8)	1–7	3–90
Severe Hypocalcemia	48 (18.2)	48 (22.1)	–	1–7	3–90
Cutaneous Necrosis	2 (0.8)	2 (0.9)	–	3–7	90–120

Table 2. Comparison of relevant clinical parameters between SHPT patients with and without complications.

Variables	With complications (27)	Without complications (186)	p
Baseline
Female (n)	13	107	0.840
Age (years)	51.0 ± 12.2	50.8 ± 13.2	0.914
Vintage of dialysis (months)	114 (0–240)	108 (0–288)	0.880
History of PTX (n)	12	46	0.031
Presenting symptoms
No. of Symptoms	3 (0–7)	2 (0–5)	0.000
Bone pain (n)	18	134	0.649
Pruritus (n)	11	57	0.377
Lumbar X-ray of renal osteodystrophy (n)	14	88	0.685
Laboratory examination
Pre-MWA iPTH (pg/ml)	1154.6 (121–3149)	1064.3 (93–6800)	0.902
Reduction in iPTH (pg/ml)	888.9 (51.2–2958.1)	822.6 (10.4–6308.5)	0.628
Lowest Post-MWA iPTH (pg/ml)	125.3 (21–1014.9)	167.1 (2.7–2443.5)	0.310
Serum calcium (mmol/L)	2.5 ± 0.3	2.5 ± 0.3	0.729
Serum phosphorus (mmol/L)	1.7 ± 0.7	1.9 ± 0.6	0.115
ALP (U/L)	124 (35–3225)	145 (51–2489)	0.656
25 (OH)D (nmol/L)	34.3 (20.2–119.8)	33.2 (11–115.1)	0.524
Parathyroid glands
No. of glands (n)	2 (1–4)	2 (1–4)	0.232
Volume (ml)	1.4 (0.2–13.8)	1.4 (0.1–16.0)	0.498
Ablation Time (s)	346 (122–1262)	287 (35–2060)	0.208

ALP: alkaline phosphatase; iPTH: intact parathyroid hormone; MWA: microwave ablation; PTX: parathyroidectomy.

Figure 2. (a)Transverse US scan in a 69-year-old SHPT patient shows a parathyroid nodule (white arrow) behind inferior left lobe of thyroid abutting the trachea (T) and esophagus (E). (b–c) One and 21 months after MWA, US image shows the shrunken ablation zone(white arrow) clings to the area of the recurrent laryngeal nerve. (d–e) The left vocal cord (white arrow) loses tension, atrophies to be arched and becomes thin under eupnea on US. The left vocal cord is located on one side and could not close the glottis. Laryngoscopy revealed atrophic and thin left vocal cord.

Figure 3. (a) An ectopic parathyroid nodule (white arrow) was on the lateral side of the left carotid sheath. (b) A liquid-isolating zone around the nodule (white triangle). (c) The procedure of MWA. (d) One month after MWA, the nodule showed a reduction in volume on US and the ablation zone (white arrow) was close to middle cervical sympathetic ganglion (MCSG) (yellow arrow).

Figure 4. (a) Preablation fingertip necrosis. (b) Seven days later the skin necrosis involved the entire forearm. (c–d) Debridement plus autologous skin transplantation.