US-guided laser treatment of parathyroid adenomas

Figures & data

Table 1. patient demographic and laboratory details.

	Age	Sex	Parathyroid maximum diameter (cm)	Location in relation to thyroid	Clinical symptoms	Pretreatment calcium levels (mg/dL)	Pretreatment PTH levels (pg/mL)
1	43	F	1	Caudal	Repeat renal colic	10.5	259
2	71	F	1.3	Retrothyroidal	Bone pain, renal stones	11	92
3	85	F	3	Caudal	Renal colic, nausea and vomiting	13.3	900
4	65	F	2	Caudal	Increasing bone pain and arthralgia	11.8	371
5	69	F	1.3	Caudal	Severe osteoporosis	12.1	367
6	69	F	1.6	Retrothyroidal	Nephrolithiasis, severe osteoporosis	9.9	151
7	53	F	1.2	Caudal	Repeated renal colic, nausea and vomiting	10.3	128
8	81	M	1.3	Retrothyroidal	Severe arthralgia and increasing bone pain	11.3	290
9	78	F	1.1	Retrothyroidal	Nephrocalcinosis	11.4	127
10	41	M	1.7	Caudal	Severe bone pain, repeat renal colic	13.8	2000
11	75	F	0.9	Caudal	Bone pain and arthralgias	11.5	150
12	67	M	1.6	Caudal	Renal colic, vomiting	10.1	160

Figure 1. Single-fiber laser ablation for primary hyperparathyroidism. (A) A 69-year-old female presented with severe osteoporosis, nephrocalcinosis and elevated parathormone levels. A 1.6 × 0.6 cm adenoma was identified behind the lower pole of the thyroid. (B) Contrast enhanced ultrasound confirms marked homogeneous vascularity. (C) Gray scale ultrasonography demonstrates insertion of a single fiber (central white line) along the longitudinal axis of the gland. Normalization of parathormone was noted at 6 months. (D) Two-year follow-up shows a marked reduction in the gland size (0.7 × 0.4 cm) with elimination of vascularity at contrast enhanced ultrasound (yellow circle).

Figure 2. Dual-fiber laser ablation for primary hyperparathyroidism. (A) A 65-year-old female presented with increasing bone pain and arthralgia, increased parathormone levels and hypercalcemia. A 2.0 × 1.3 cm adenoma was identified at gray scale ultrasound caudal to the thyroid. (B) Contrast enhanced ultrasound demonstrated a heterogeneously enhancing nodule. (C) Baseline Tc-99 Sestamibi is highly positive (red color). (D) Intraprocedural gray scale ultrasound demonstrated the placement of two laser fibers spaced 1 cm apart inserted into the gland. (E) Increased echogenicity is identified surrounding the fibers during the active application of laser energy. Normalization of parathormone and calcium levels occurred by 6 months. (F) Two-year follow-up gray scale and contrast enhanced ultrasound demonstrate a non-enhancing 0.9 × 0.7 cm gland. (G) Tc-99 Sestamibi shows no evidence for increased uptake.

Table 2. The changes in serum PTH and albumin- corrected calcium levels before ablation and at each follow-up period.

	Baseline	1 Mo	6 Mo	12 Mo	24 Mo
Volume (cm^3)	0.54 ± 0.47	0.46 ± 0.42	0.36 ± 0.36	0.36 ± 0.38	0.36 ± 0.34
PTH (pg/mL) (20 to 80 pg/mL)	416 ± 230	357 ± 526	58 ± 19	52 ± 17	60.5 ± 25
Calcium (mg/dL) (8.6–10.3 mg/dl)	11.4 ± 1.2	10.6 ± 1.4	9.6 ± 0.7	9.5 ± 0.6	9.3 ± 0.7