ULTRASONICALLY GUIDED CHEMICAL PARATHYROIDECTOMY IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM - A FOLLOW-UP-STUDY

OBJECTIVE We evaluated the long-term results in two different groups o f patients with primary hyperparathyroidism treated with ultrasonicall y guided percutaneous ethanol (96%) injection into parathyroid tumours . DESIGN A prospective long-term follow-up (more than 6 months). Ethan ol (96%) was injected under ultrasonic guidance into biopsy verified s olitary parathyroid tumours. Basic treatment included a maximum of thr ee treatments with an interval of about 1 month (group 1) or 1 week (g roup 2). Dose of ethanol was half the volume of the parathyroid tumour . PATIENTS Two different groups of patients with only one ultrasonical ly detected and biopsy verified parathyroid tumour were treated. Group 1 (n = 18) were treated regardless of the severity of the hyperparath yroid disease. Group 2 (n = 14) were selected for treatment either due to severe hypercalcaemic symptoms (n = 3), a high surgical risk (n = 5), or refusal of surgery (n = 6). MEASUREMENTS The volume of the para thyroid tumours was measured as half the product of maximum length, wi dth, and depth. Blood tests included measurements of ionized calcium, total calcium and PTH. RESULTS In group 1, 12 of 18 patients (66%) cou ld be followed more than 6 months. Follow-up ranged from 12 to 58 mont hs (median 45 months). A significant decrease (P < 0.001) in serum con centrations of ionized calcium and total calcium was observed. Eight p atients (44%) later underwent surgical parathyroidectomy. Injection th erapy was regarded as successful in 10 of 18 patients (56%). In group 2, 11 of 14 patients (79%) were followed more than 6 months. Follow-up ranged from 18 to 50 months (median 39 months). A significant decreas e (P < 0.001) in serum concentrations of ionized calcium, total calciu m and intact PTH (1-84) was observed. Treatment was successful in 11 o f 14 patients (79%). Two patients required parathyroid surgery. Re-exa mination with ultrasound showed a significant reduction in the volume of the treated parathyroid tumours. Fibrosis surrounding the parathyro id tumours was detected in eight of 10 patients who subsequently had o perations. One patient from each group had a complication of a unilate ral permanent vocal cord paralysis following injection therapy. CONCLU SION Partial or complete long-term remission of primary hyperparathyro idism can be achieved using ultrasound-guided chemical parathyroidecto my. However, the intervals between treatments should be short and the treatment should be reserved only for patients not fit for surgery.