Thermal Ablation Versus Parathyroidectomy for Primary Hyperparathyroidism

Inclusion Criteria: * Symptomatic patients with primary hyperparathyroidism, such as those with symptoms in any system including the kidneys, bones, gastrointestinal tract, psychoneurological system, or those with atypical symptoms such as muscle weakness, dysfunction, and sleep disorders. * Asymptomatic PHPT patients with any of the following conditions: ① Serum calcium is higher than the upper limit of the normal value by 1 mg/dL (0.25 mmol/L); ② There is objective evidence of renal involvement, including asymptomatic kidney stones, nephrocalcinosis, hypercalciuria (24 - hour urinary calcium level \> 400 mg/dL) on renal imaging, or impaired renal function (glomerular filtration rate \< 60 mL/min); ③ There is evidence of osteoporosis (bone mineral density decreased by 2.5 standard deviations at any site) and/or radiographic evidence of fragility fractures. ④ Age \< 50 years ⑤ The patient cannot accept routine follow - up observation. * Imaging examination shows that at least one parathyroid gland is enlarged. Exclusion Criteria: * diagnosis of secondary or tertiary HPT * severe coagulation disorder * severe cardiopulmonary insufficiency