Primary hyperparathyroidism is one of the most common endocrine diseases and is defined as the inappropriate overproduction of parathyroid hormone, resulting in hypercalcemia. It occurs mostly as a result of parathyroid adenoma or hyperplasia. The incidence of primary hyperparathyroidism increases with advancing age. The standard treatment of symptomatic primary hyperparathyroidism is parathyroidectomy; however, in older patients with multiple comorbidities, the risks associated with surgical treatment involving general anesthesia are high. Compared with surgery, radiofrequency abalation (RFA) is a minimally invasive procedure, in which the mass is removed. We here present a case of an elderly patient with primary hyperparathyroidism associated with parathyroid adenoma who was successfully treated with ultrasonography-guided RFA. RFA is an alternative therapeutic option for treatment of primary hyperparathyroidism for high-risk elderly patients, and further evaluation of its clinical value is warranted.