Objective To investigate the safety and efficacy of microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT). Methods Clinical data of 6 patients with totally 6 PHPT nodules managed by MWA in our center from August 2014 to July 2015 were collected and retrospectively analyzed. They underwent multiple point ablation therapy at a power of 25-30 W. After MWA, ultrasound examination was used to evaluate the efficacy of the ablation. The changes in intact parathyroid hormone (iPTH), and serum levels of calcium and phosphorus before and after the operation were detected and analyzed. Results The ablation time of one PHPT nodule was 550-840 (638±138) s. In 1 d after MWA, the level of iPTH was decreased from (479.2±477.3)ng/L preoperatively to (69.3±49.8)ng/L (P>0.05), while that of calcium was declined from (2.57±0.13)mmol/L to (2.08±0.15)mmol/L (P<0.05). Their levels were slightly increased at the end of follow-up (P>0.05). There was no obvious change in the serum level of phosphorus before and after MWA (P>0.05). No complication was found during and after MWA treatment. Conclusion MWA is safe and effective in the treatment of PHPT, and can obviously decrease the levels of iPTH and serum calcium. It might become an alternative for surgical treatment in the management of PHPT.