Eldeiry Leslie S, Faintuch Salomao, Sacks Barry A
Department of Endocrinology, Atrius Health and Harvard Medical School, Boston, Massachusetts.
Department of Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
AACE Clin Case Rep. 2024 Aug 30;10(6):253-256. doi: 10.1016/j.aace.2024.08.009. eCollection 2024 Nov-Dec.
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.
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.
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.
RFA, with or without ethanol ablation, can be considered as an alternative to surgery for patients with persistent hyperparathyroidism after parathyroidectomy.
背景/目的：对于无法或不愿接受手术的原发性甲状旁腺功能亢进患者，射频消融（RFA）已越来越多地被用作手术替代方案。
我们报告一例64岁女性患者，她因原发性甲状旁腺功能亢进合并骨质疏松症接受了手术。术前四维计算机断层扫描成像提示多腺体疾病；然而，甲状旁腺探查术后她仍存在持续性甲状旁腺功能亢进。通过超声（US）对其影像学检查进行重新评估，并在超声引导下对甲状旁腺激素洗脱进行细针穿刺抽吸，从而发现了甲状腺内甲状旁腺腺瘤，该腺瘤通过射频消融联合乙醇注射成功治疗。
该病例说明了超声及超声引导下细针穿刺抽吸在识别甲状腺内甲状旁腺腺瘤方面的作用，以及一种将射频和经皮乙醇消融相结合的新技术成功治疗甲状旁腺手术失败患者的情况。
对于甲状旁腺切除术后仍存在持续性甲状旁腺功能亢进的患者，无论是否进行乙醇消融，射频消融都可被视为手术的替代方案。
