Successful Radiofrequency Ablation of an Intrathyroidal Parathyroid Adenoma After Failed Parathyroidectomy.

Background/objective: Radiofrequency ablation (RFA) has been increasingly used as an alternative to surgery in patients with primary hyperparathyroidism who are unable or unwilling to have surgery.

Case report: We present a case of a 64-year-old woman who had surgery for primary hyperparathyroidism complicated by osteoporosis. Preoperative imaging with 4-dimensional computed tomography scan suggested multigland disease; however, she had persistent hyperparathyroidism after parathyroid exploration. Reevaluation of her imaging studies with ultrasound (US) and US-guided fine needle aspiration for parathyroid hormone washout led to identification of an intrathyroidal parathyroid adenoma that was successfully treated by RFA followed by ethanol injection.

Discussion: The case illustrates the utility of US and US-guided fine needle aspiration for the identification of intrathyroidal parathyroid adenomas, as well as successful treatment of a patient who had failed parathyroid surgery, with a combination of both radiofrequency and percutaneous ethanol ablation, a novel technique.

Conclusion: RFA, with or without ethanol ablation, can be considered as an alternative to surgery for patients with persistent hyperparathyroidism after parathyroidectomy.