Thermal ablation for primary and secondary hyperparathyroidism is an option for patients unfit for or hesitant for surgery. Apart from being a scarless procedure performed under local anesthesia, it also presents the prospect of not interfering with thyroid vascularization and function. Anatomical considerations are pivotal for this approach since vital structures are adjacent to the parathyroid glands. Identifying and considering the parathyroid position and tailoring the energy delivered will allow safe and effective treatment.