In the previous two articles, I highlighted respectively that the parathyroid glands are an endocrine organ that deserves high priority and should no longer be neglected, and also pointed out which groups of people need to be on high alert for parathyroid disorders. From the perspective of its endocrine function status, the parathyroid glands can be hyperparathyroid or hypoparathyroid, with the former being the most predominant. From the perspective of pathological changes, there are adenomas, hyperplasia, adenocarcinoma and cysts. So, how to choose the treatment for hyperparathyroidism if you are unfortunately suffering from it? Primary hyperparathyroidism (PHPT) The main causes of primary hyperparathyroidism are adenoma, hyperplasia and adenocarcinoma, while adenocarcinoma is relatively rare. The diseased gland cells secrete excess parathyroid hormone, which leads to kidney stones (often persistent), decreased bone density, fractures (femur, ankle, and tibia fractures are more common), lethargy and poor nasal function, depression, and other non-characteristic manifestations. Five minutes before writing this article, I just read a medical information about hyperparathyroidism. The patient had undergone several surgeries to remove stones from her kidneys, but no one had thought about the possibility of hyperparathyroidism. Usually parathyroid adenomas occur in only one parathyroid gland (humans usually have 4 normal parathyroid glands), and by removing or inactivating this adenoma, the source of excessive parathyroid hormone production can be eliminated and hyperparathyroidism can be cured. It is important to note that there is no way to reverse an already formed kidney stone, but it is possible to stop its further growth. Other symptoms will also be significantly relieved or disappear. With the rapid development of minimally invasive medical technology, parathyroid adenomas and hyperplasia no longer rely on surgical treatment. The most representative treatment at present is ultrasound-guided percutaneous percutaneous ablation, and the specific options are chemical ablation treatment with anhydrous alcohol injection, microwave or radiofrequency or laser thermal ablation treatment. The method, technique and equipment requirements for anhydrous alcohol injection are relatively simple and easy to carry out, but the effect is relatively poor and complications of laryngeal nerve injury are relatively common. At present, the most cutting-edge technology is microwave, radiofrequency, laser thermal ablation treatment, known as ultra-minimally invasive treatment. The first one in China to carry out thermal ablation and the one with the largest number of cured cases is the interventional ultrasound treatment group led by Zhang Jianquan, director of the ultrasound department of Shanghai Long March Hospital. For parathyroid adenomas and hyperplasia, thermal ablation treatment can cure them once and for all, resulting in a rapid and significant decrease in parathyroid hormones. Second, secondary hyperparathyroidism (SHPT) Secondary hyperparathyroidism mainly occurs in uremic hemodialysis (some abdominal dialysis) patients. Generally, hyperparathyroidism starts to appear about 3 years after hemodialysis, and it occurs in about 90% of hemodialysis patients. Patients often have more serious skeletal deformities, fractures, ectopic calcification, skin itching, Cardiovascular calcification, among other problems, seriously impairs the quality of life of patients. Due to the loss of renal function in uremic patients, hypocalcemia and hyperphosphatemia occur, stimulating hyperplasia of the parathyroid glands, mostly in four glands simultaneously or sequentially. For secondary hyperparathyroidism, medical medication is usually administered first, focusing on calcium supplementation and enhancing calcium absorption, such as taking calcium tablets and rogaine. However, a significant number of patients are insensitive to drug therapy and the results are not significant. When parathyroid hormones are persistently elevated and the associated damage is not effectively controlled, surgical removal of the hyperplastic parathyroid glands is often required. However, since the patient’s general condition is poor and he or she tolerates surgery poorly, minimally invasive ablation methods have gradually emerged as an alternative to surgery, the most effective being microwave and radiofrequency thermal ablation therapy. Triple hyperparathyroidism (THPT) Triple hyperparathyroidism refers to the transformation of the original secondary parathyroid hyperplasia into adenoma-like continuous secretion of parathyroid hormone after kidney transplantation in uremic patients, with some characteristics similar to primary hyperparathyroidism, and the formation of stones in the transplanted kidney. The transplanted kidney is very valuable and once stones are formed it will add endless mental burden to the patient. Therefore, for patients after kidney transplantation, parathyroid ultrasound should be checked early once parathyroid hormone is found to fail to fall, and timely minimally invasive treatment should be given. Treatment options for ectopic parathyroid adenoma or hyperplasia in the mediastinum The parathyroid glands are prone to ectopic in the mediastinum. Sometimes the four parathyroid glands in the neck remain normal while the ectopic parathyroid glands develop adenoma or hyperplasia, and the suitability of ultrasound-guided percutaneous percutaneous microwave, radiofrequency, or laser ablation therapy should be determined according to the specific location of the ectopic adenoma. For ectopic adenomas with deeper location and complex surrounding conditions, surgical resection is still the mainstay.