Primary hyperparathyroidism (PHPT) frequently presents management challenges in older populations due to high surgical and anesthetic risks. Traditionally, parathyroidectomy serves as the definitive treatment for this endocrine disorder. However, RFA for primary hyperparathyroidism is emerging as a potent minimally invasive alternative for those ineligible for surgery. A recent retrospective cohort study evaluated the efficacy and safety of this ultrasound-guided procedure in patients aged 60 and older.

Study Overview and Cure Rates

Researchers analyzed 36 elderly patients who underwent ultrasound-guided radiofrequency ablation between May 2021 and May 2025. Initially, a single RFA session achieved a cure in 28 patients. When the team included repeat procedures, the overall cure rate rose significantly to 83.3%. Consequently, the study demonstrates that RFA effectively normalizes serum calcium and intact parathyroid hormone (iPTH) levels in a majority of elderly subjects. Furthermore, the procedure avoids the complications typically associated with general anesthesia in frail patients.

Outcomes of RFA for Primary Hyperparathyroidism

The study found no major life-threatening complications, highlighting a favorable safety profile. Specifically, biochemical parameters showed consistent improvement throughout the six-month follow-up period. Moreover, the minimally invasive nature of RFA allows for faster recovery times compared to traditional neck exploration. Therefore, this technique provides a high-value option for maintaining normocalcemia in geriatric patients who face elevated surgical morbidity.

Safety Profile and Risk Factors

Common procedure-related adverse events included mild postoperative pain and hoarseness. Most cases of hoarseness were transient and resolved without intervention. However, one patient experienced permanent hoarseness following the procedure. Notably, older age and lower baseline magnesium levels were identified as factors that increased the risk of vocal complications. Thus, clinicians should carefully monitor electrolytes and conduct thorough pre-procedural assessments to mitigate these risks.

Conclusion

In summary, ultrasound-guided RFA represents an effective and safe alternative for selected elderly or frail patients with PHPT. It achieves acceptable cure rates while maintaining a low incidence of major complications. As medical technology advances, RFA may soon become a standard alternative to surgery for high-risk surgical candidates. Consequently, larger prospective studies are warranted to further validate these promising findings in diverse populations.

Frequently Asked Questions

Is RFA for primary hyperparathyroidism as effective as surgery?

While surgery remains the primary standard of care, RFA achieved an 83.3% cure rate in this elderly cohort. It is a highly effective alternative for patients who are at high risk for traditional surgery.

What are the common side effects of parathyroid RFA?

The most frequent side effects include mild postoperative pain and temporary hoarseness. Permanent complications, such as lasting voice changes, are extremely rare but can occur.

Why is RFA preferred for elderly or frail patients?

RFA is minimally invasive and can often be performed under local anesthesia. This reduces the cardiovascular and respiratory risks associated with general anesthesia in the elderly population.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Alkan S et al. Ultrasound-Guided Radiofrequency Ablation for the Treatment of Primary Hyperparathyroidism in Elderly Patients. Clin Endocrinol (Oxf). 2026 Apr 02. doi: 10.1111/cen.70138. PMID: 41928071.

Wei Y, Peng C, Li J, et al. Efficacy and Safety of Microwave and Radiofrequency Ablation in the Treatment of Hyperparathyroidism in Older Individuals: A Multicenter Prospective Study. Radiology. 2025;312(3):e243359. doi:10.1148/radiol.243359.