Primary hyperparathyroidism is a common endocrine metabolic disorder that can lead to multisystem target-organ damage, substantially impairing patients' quality of life and long-term prognosis. In recent years, ultrasound-guided thermal ablation has emerged as a minimally invasive treatment option for primary hyperparathyroidism and has demonstrated reliable efficacy with an acceptable safety profile in multiple studies. This review summarizes the research background, technical aspects, therapeutic outcomes, and complication management of thermal ablation in the treatment of primary hyperparathyroidism, with the goal of informing clinical practice and guiding future investigations.