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Ultrasound-Guided Radiofrequency Ablation in Tertiary Hyperparathyroidism: A Prospective Study

  • Erya Deng (Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University) ;
  • Tingting Jiang (Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University) ;
  • Huihui Chai (Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University) ;
  • Ning Weng (Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine) ;
  • Hongfeng He (Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College) ;
  • Zhengxian Zhang (Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine) ;
  • Chengzhong Peng (Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University) ;
  • Wenwen Yue (Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University) ;
  • Huixiong Xu (Department of Ultrasound, Zhongshan Hospital, Fudan University)
  • Received : 2023.02.25
  • Accepted : 2023.12.08
  • Published : 2024.03.01

Abstract

Objective: To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT). Materials and Methods: Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA. Results: A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05). Conclusion: US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.

Keywords

Acknowledgement

This work was supported in part by the National Natural Science Foundation of China (Grant no: 82272005), Shanghai Municipal Health Commission (Grant no: SHSLCZDZK 03502 and 19441903200) and Science and Technology Commission of Shanghai Municipality (Grant no: 19DZ2251100 and 2019LJ21).

References

  1. Xu Y, Evans M, Soro M, Barany P, Carrero JJ. Secondary hyperparathyroidism and adverse health outcomes in adults with chronic kidney disease. Clin Kidney J 2021;14:2213-2220  https://doi.org/10.1093/ckj/sfab006
  2. Ben-Dov IZ, Galitzer H, Lavi-Moshayoff V, Goetz R, Kuro-o M, Mohammadi M, et al. The parathyroid is a target organ for FGF23 in rats. J Clin Invest 2007;117:4003-4008  https://doi.org/10.1172/JCI32409
  3. Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol 2005;288:F253-F264  https://doi.org/10.1152/ajprenal.00302.2004
  4. Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med 2005;35:266-276  https://doi.org/10.1053/j.semnuclmed.2005.06.001
  5. Tang JA, Friedman J, Hwang MS, Salapatas AM, Bonzelaar LB, Friedman M. Parathyroidectomy for tertiary hyperparathyroidism: a systematic review. Am J Otolaryngol 2017;38:630-635  https://doi.org/10.1016/j.amjoto.2017.06.009
  6. Sutton W, Chen X, Patel P, Karzai S, Prescott JD, Segev DL, et al. Prevalence and risk factors for tertiary hyperparathyroidism in kidney transplant recipients. Surgery 2022;171:69-76  https://doi.org/10.1016/j.surg.2021.03.067
  7. Hsu CY, Chen LR, Chen KH. Osteoporosis in patients with chronic kidney diseases: a systemic review. Int J Mol Sci 2020;21:6846 
  8. Lemoine S, Figueres L, Bacchetta J, Frey S, Dubourg L. Calcium homeostasis and hyperparathyroidism: nephrologic and endocrinologic points of view. Ann Endocrinol (Paris) 2022;83:237-243  https://doi.org/10.1016/j.ando.2022.05.003
  9. Ozdemir FN, Afsar B, Akgul A, Usluog˘ullari C, Akcay A, Haberal M. Persistent hypercalcemia is a significant risk factor for graft dysfunction in renal transplantation recipients. Transplant Proc 2006;38:480-482  https://doi.org/10.1016/j.transproceed.2005.12.065
  10. Egbuna OI, Taylor JG, Bushinsky DA, Zand MS. Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure. Clin Transplant 2007;21:558-566  https://doi.org/10.1111/j.1399-0012.2007.00690.x
  11. Levy AR, Xing S, Brunelli SM, Cooper K, Finkelstein FO, Germain MJ, et al. Symptoms of secondary hyperparathyroidism in patients receiving maintenance hemodialysis: a prospective cohort study. Am J Kidney Dis 2020;75:373-383  https://doi.org/10.1053/j.ajkd.2019.07.013
  12. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 2009;113:S1-S130 
  13. Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, et al. The American Association of endocrine surgeons guidelines for the definitive surgical management of secondary and tertiary renal hyperparathyroidism. Ann Surg 2022;276:e141-e176  https://doi.org/10.1097/SLA.0000000000005522
  14. Chen Z, Cheng L, Zhang W, He W. Ultrasound-guided thermal ablation for hyperparathyroidism: current status and prospects. Int J Hyperthermia 2022;39:466-474  https://doi.org/10.1080/02656736.2022.2028907
  15. Hu Z, Han E, Chen W, Chen J, Chen W, Guo R. Feasibility and safety of ultrasound-guided percutaneous microwave ablation for tertiary hyperparathyroidism. Int J Hyperthermia 2019;36:1129-1136  https://doi.org/10.1080/02656736.2019.1684576
  16. Li X, An C, Yu M, Peng L. US-guided microwave ablation for secondary hyperparathyroidism in patients after renal transplantation: a pilot study. Int J Hyperthermia 2019;36:322-327  https://doi.org/10.1080/02656736.2019.1566580
  17. Douthat WG, Orozco SE, Maino P, Cardozo G, de Arteaga J, de la Fuente J, et al. Percutaneous ethanol injection therapy in post-transplant patients with secondary hyperparathyroidism. Transpl Int 2007;20:1031-1035  https://doi.org/10.1111/j.1432-2277.2007.00545.x
  18. Tominaga Y. Management of renal hyperparathyroidism. Biomed Pharmacother 2000;54(Suppl 1):25s-31s  https://doi.org/10.1016/S0753-3322(00)80007-4
  19. Choi HR, Aboueisha MA, Attia AS, Omar M, ELnahla A, Toraih EA, et al. Outcomes of subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for tertiary hyperparathyroidism: multi-institutional study. Ann Surg 2021;274:674-679  https://doi.org/10.1097/SLA.0000000000005059
  20. Peng C, Zhang Z, Liu J, Chen H, Tu X, Hu R, et al. Efficacy and safety of ultrasound-guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease. Head Neck 2017;39:564-571  https://doi.org/10.1002/hed.24657
  21. Mauri G, Pacella CM, Papini E, Solbiati L, Goldberg SN, Ahmed M, et al. Image-guided thyroid ablation: proposal for standardization of terminology and reporting criteria. Thyroid 2019;29:611-618  https://doi.org/10.1089/thy.2018.0604
  22. Lin YS, Hsueh C, Wu HY, Yu MC, Chao TC. Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia. Laryngoscope 2017;127:2194-2200  https://doi.org/10.1002/lary.26448
  23. Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res 2016;205:70-75  https://doi.org/10.1016/j.jss.2016.06.019
  24. Moreno P, Coloma A, Torregrosa JV, Montero N, Francos J, Codina S, et al. Long-term results of a randomized study comparing parathyroidectomy with cinacalcet for treating tertiary hyperparathyroidism. Clin Transplant 2020;34:e13988 
  25. Rivelli GG, Lima ML, Mazzali M. Therapy for persistent hypercalcemic hyperparathyroidism post-renal transplant: cinacalcet versus parathyroidectomy. J Bras Nefrol 2020;42:315-322  https://doi.org/10.1590/2175-8239-jbn-2019-0207
  26. Ramonell KM, Lindeman B, Chen H, Fazendin J. Parathyroidectomy for normocalcemic tertiary hyperparathyroidism: a 19-year experience. J Surg Res 2022;276:362-368  https://doi.org/10.1016/j.jss.2022.02.011
  27. Kovacs DA, Fedor R, Asztalos L, Andrasi M, Szabo RP, Kanyari Z, et al. Surgical treatment of hyperparathyroidism after kidney transplant. Transplant Proc 2019;51:1244-1247  https://doi.org/10.1016/j.transproceed.2019.03.008
  28. Patecki M, Scheffner I, Haller H, Gwinner W. Long-term renal graft outcome after parathyroidectomy - a retrospective single centre study. BMC Nephrol 2020;21:53 
  29. Li D, Wang G, Chen X, Guo W, Huang H, Diao Z, et al. Long-term effect of microwave ablation on patients undergoing hemodialysis for moderate secondary hyperparathyroidism: a retrospective cohort study. J Ultrasound Med 2021;40:2497-2505  https://doi.org/10.1002/jum.15638
  30. Diao Z, Qian L, Teng C, Zhang N, Liang J, Kong L, et al. Microwave ablation versus parathyroidectomy for severe secondary hyperparathyroidism in patients on hemodialysis: a retrospective multicenter study. Int J Hyperthermia 2021;38:213-219  https://doi.org/10.1080/02656736.2021.1885754
  31. Qin X, Wang B, Li B, Lin C, Liu X, Xie X. Value of contrast-enhanced ultrasonography in radiofrequency ablation of secondary hyperparathyroidism. Ren Fail 2021;43:445-451  https://doi.org/10.1080/0886022X.2021.1889601
  32. Wei Y, Peng LL, Zhao ZL, Li Y, Yu MA. Risk factors of severe hypocalcemia after us-guided percutaneous microwave ablation of the parathyroid gland in patients with secondary hyperparathyroidism. J Bone Miner Res 2020;35:691-697  https://doi.org/10.1002/jbmr.3934
  33. Rayes N, Seehofer D, Schindler R, Reinke P, Kahl A, Ulrich F, et al. Long-term results of subtotal vs total parathyroidectomy without autotransplantation in kidney transplant recipients. Arch Surg 2008;143:756-761; discussion 761  https://doi.org/10.1001/archsurg.143.8.756
  34. Faye M, Keita N, Lemrabott AT, Algouzmari I, Faye M, Mbengue M, et al. Surgical management of secondary hyperparathyroidism in dialysis patients in Senegal. Saudi J Kidney Dis Transpl 2021;32:1424-1430 
  35. Zhao J, Qian L, Teng C, Yu M, Liu F, Liu Y, et al. A short-term non-randomized controlled study of ultrasound-guided microwave ablation and parathyroidectomy for secondary hyperparathyroidism. Int J Hyperthermia 2021;38:1558-1565  https://doi.org/10.1080/02656736.2021.1904153
  36. Meng C, Martins P, Frazao J, Pestana M. Parathyroidectomy in persistent post-transplantation hyperparathyroidism-single-center experience. Transplant Proc 2017;49:795-798 https://doi.org/10.1016/j.transproceed.2017.01.067