Primary hyperparathyroidism during pregnancy is a rare disease with a prevalence of less than 1% among pregnant women that can cause serious complications such as nephrolithiasis, pancreatitis, preeclampsia, and adverse fetal outcomes including growth restriction, miscarriage, or stillbirth.[1] The standard treatment is surgical parathyroidectomy in the second trimester, but in some cases it is not possible due to gestational age, contraindications, or patient refusal.[1] The article describes the case of a 38-year-old woman in her second trimester with hypercalcemia and elevated parathyroid hormone, who was diagnosed with parathyroid adenoma.[1] The patient refused surgery, so ultrasound-guided microwave ablation was performed under local anesthesia with protection of adjacent structures.[1] Within one hour after the procedure, parathyroid hormone dropped from 100.3 pg/ml to 16.8 pg/ml and calcium normalized to 10.0 mg/dL.[1] Symptoms resolved within a few days and values remained stable for the remainder of the pregnancy.[1] At 38 weeks, the patient gave birth to a healthy baby by caesarean section without complications for the mother or the fetus.[1] This case represents only the second reported use of microwave ablation for primary hyperparathyroidism during pregnancy and demonstrates its feasibility and safety as a minimally invasive alternative when surgery is contraindicated or refused.[1]