Early endocrine, bone, and inflammatory responses to microwave ablation for hyperparathyroidism: preliminary study

Purpose: To investigate short-term changes in hormonal, bone metabolic, and inflammatory markers after ultrasound-guided microwave ablation (MWA) in patients with hyperparathyroidism (HPT). Methods: Nineteen patients (14 with primary HPT[PHPT], 5 with secondary HPT[SHPT]) underwent MWA. Serum intact parathyroid hormone (iPTH), calcium, phosphate, alkaline phosphatase (ALP), bone turnover markers [e.g., procollagen type I N-terminal propeptide (PINP), bone-specific ALP (BALP), fibroblast growth factor-23 (FGF-23), etc.], and inflammatory markers [e.g., C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), etc.] were measured at baseline, day 1, and month 1 post-ablation. Results: iPTH and calcium decreased by day 1 (both P < 0.001); iPTH remained reduced at month 1 (P < 0.001), while calcium slightly increased (P = 0.046). Phosphate showed a borderline upward trend (P = 0.050), and ALP decreased at month 1 (P = 0.044). PINP increased at month 1 (P = 0.011; day 1 to month 1 P = 0.001), BALP trended upward (P = 0.112), and FGF-23 declined over time (P = 0.015). CRP peaked at day 1 and decreased by month 1 (P = 0.036); other cytokines remained unchanged. In PHPT, iPTH and calcium decreased on day 1 (both P ≤ 0.001), PINP increased by month 1 (P = 0.013), and FGF-23 declined (P = 0.009). In SHPT, trends were directionally similar but not statistically significant; calcium decreased on day 1 (P = 0.043) and rebounded by month 1. No severe hypocalcemia occurred; two patients experienced transient hoarseness. Conclusion: Microwave ablation induces rapid biochemical normalization and early skeletal and inflammatory changes in patients with hyperparathyroidism.