Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study

Figures & data

Table 1. The baseline of patients with recurrent and persistent SHPT.

Item	Parameters
Gender (male/female)	3/8
Age (years)	34–69 (51.3 ± 11)
Underlying nephropathy causes
Nephritis	7/11 (63.6%)
Drug-induced renal damage	2/11 (18.2%)
Hypertension	1/11 (9.1%)
Hyperpyrexia	1/11 (9.1%)
History of treatment
Drug therapy	11/11 (100%)
Parathyroidectomy (times/no. of cases)	1/8, 2/2, 3/1
Renal transplant cases	2/11 (18.2%)
CKD-associated complications
Tendon rupture	3/11 (27.3%)
Anaemia	3/11 (27.3%)
Hypertension	7/11 (63.6%)
Hyperparathyroidism
Persistent cases	3/11 (27.3%)
Recurrent cases	8/11 (72.7%)
Symptom
Ostalgia	9/11 (81.8%)
Pruritus	7/11 (63.6%)
Myasthenia	8/11 (72.7%)
Restless legs	4/11 (36.4%)
Dialysis time (years)	4–20 (10.6 ± 5)
Haemodialysis cases	10/11 (90.9%)
Non-dialysis cases	1/11 (9.1%)
Co-morbidity
Diabetes cases	0
Coronary disease cases	4/11 (36.4%)
Follow-up (months)	4–12 (6.8 ± 2.4)

Table 2. The conditions of nodules and parameters of MWA in 11 patients with recurrent and persistent SHPT.

Item	Parameters
Nodule in ultrasound
Total nodule number	16
Number of nodules/cases	1/8, 2/1, 3/2
Maximum diameter (cm)	0.8–1.9 (1.3 ± 0.3)
Position
Normal position	10/16 (62.5%)
Ectopic	6/16 (37.5%)
CDFI inside nodule
Blood signal	10/16 (62.5%)
Non-blood signal	6/16 (37.5%)
Pre-operative CEUS
Uniformity hyper-enhancement	9/16 (56.3%)
Non-uniform hyper-enhancement	7/16 (43.8%)
Ablation
Space fluid injection	16/16 (100%)
Total ablation time in s/nodule	147–484 (305 ± 131)
Number of ablation units/nodules	4–8 (4.8 ± 1.3)
Post-operative CEUS
Complete ablation	16/16 (100%)
Major complication	0
Minor complication or side effects
Intraoperative pain	9/11 (81.8%)
Haematoma	1/11 (9.1%)
Transient hoarseness	3/11 (27.3%)
Hypocalcaemia	9/11 (81.8%)

Table 3. The comparative results of various test parameters between before and after MWA in patients with recurrent and persistent SHPT.

	iPTH (15–88 pg/mL)	Calcium (2.03–2.54 mmol/L)	Phosphorus (0.97–1.62 mmol/L)	ALP (45–125 U/L)
Pre-MWA	651–6800 (1570 ± 1765)	2.1–2.79 (2.51 ± 0.23)	0.8–2.49 (1.80 ± 0.43)	81–2019 (384 ± 566)
1 day after MWA	17.5–665 (287 ± 239)	1.58–2.48 (2.06 ± 0.27)	1–2.08 (1.48 ± 0.32)	86–1869 (361 ± 523)
End of follow-up	21–1500 (419 ± 438)	2.1–2.7 (2.32 ± 0.15)	1–2.2 (1.32 ± 0.37)	70–1500 (310 ± 417)
	p value
Pre-MWA vs 1 day after	0.030	0.002	0.011	0.190
Pre vs end	0.021	0.015	0.011	0.135
1 day after vs end	0.219	0.019	0.225	0.153

Figure 1. A 55-year-old female patient with a recurrent and ectopic SHPT nodule in the suprasternal fossa 3 years after parathyroidectomy that was treated by microwave ablation (MWA). (A) A hypoechoic nodule (thin arrow) without a blood signal beside the carotid artery (thick arrow) was disclosed by ultrasound. (B) A uniform hyper-enhancement of the nodule (thin arrow) beside the carotid artery (thick arrow) was displayed in CEUS pre-ablation. (C) The CT scan showed that the nodule is in the suprasternal fossa (thin arrow). (D) The nodule has radioactivity concentration (black arrow) in the late phase on MIBI scan. (E) The hyperechoic signal emerging inside the nodule (thin arrow) beside the carotid artery (thick arrow) during ablation. (F) A non-enhancement area covered the nodule (thin arrow) beside the carotid artery (thick arrow) after MWA, suggesting complete ablation was achieved by MWA.

Table 4. Medication details for treatment of SHPT patients prior to microwave ablation (MWA) and afterwards.

	Medication
Patient	Prior to MWA	Post-MWA
1	Calcium acetate, Rocaltrol	Calcium acetate
2	Calcium acetate, lanthanum carbonate	Calcium acetate, alphacalcidol
3	No	Calcium carbonate, Rocaltrol
4	Lanthanum carbonate	No
5	Rocaltrol, calcium carbonate	Rocaltrol, calcium carbonate
6	Rocaltrol, calcium carbonate	Rocaltrol, calcium carbonate
7	Rocaltrol, calcitonin	Rocaltrol, niacin
8	Alpha D3, calcium carbonate	Alpha D3, calcium carbonate
9	Rocaltrol	Rocaltrol
10	Calcium carbonate, lanthanum carbonate	Calcium carbonate, lanthanum carbonate, Rocaltrol
11	Cinacalcet	No

Table 5. The improvement of hyperparathyroidism-related symptoms in patients with recurrent and persistent SHPT before and after MWA.

		Post-MWA
	Pre-MWA	Non-improvement	Improvement	Disappearance
Hypertension (cases)	7	5 (71.4%)	0	2 (28.6%)
Ostalgia (cases)	9	1 (11.1%)	4 (44.4%)	4 (44.4%)
Pruritus (cases)	7	0	2 (28.6%)	5 (71.4%)
Myasthaenia (cases)	8	0	3 (37.5%)	5 (62.5%)
Restless legs (cases)	4	0	0	4 (100%)