Effect of recombinant human thyroid‐stimulating hormone or levothyroxine withdrawal on salivary gland dysfunction after radioactive iodine administration for thyroid remnant ablation

Iakovou, Ioannis; Goulis, Dimitrios G.; Tsinaslanidou, Zinovia; Giannoula, Evanthia; Katsikaki, Grammatiki; Konstantinidis, Iordanis

doi:10.1002/hed.23974

Cited by 14 publications

(7 citation statements)

References 14 publications

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“…In addition, Hoffman et al propose being more conservative with RAI or avoiding it when feasible in cases of low risk thyroid cancer to counteract the dose-dependent risk of sialadenitis [ 17 ]. Another study conducted by Iakovou et al showed that the use of thyrogen for preparation of RAI ablation as opposed to LT4 withdrawal reduces the prevalence of salivary gland dysfunction, possibly due to reduced hypothyroidism [ 18 ]. In our study, we could not replicate the abovementioned factors, mainly because very few subjects received thyrogen.…”

Section: Discussionmentioning

confidence: 99%

Early Sialadenitis After Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Prevalence and Predictors

Riachy

Ghazal

Haidar

et al. 2020

International Journal of Endocrinology

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Introduction. Sialadenitis is a frequent occurrence after radioactive iodine therapy (RAI). However, reports on its predictors and risk factors in the Eastern Mediterranean Region (EMRO) are scarce. Aim. This study aimed to identify risk factors for early sialadenitis in patients receiving RAI for differentiated thyroid cancer (DTC) at the American University of Beirut Medical Center. It also aimed to determine the prevalence and characteristics of such patients receiving RAI at our institution. Methods. This was a retrospective study conducted at the American University of Beirut Medical Center. Medical charts were reviewed for all patients 18–79 years of age admitted to receive RAI for DTC between 01/01/2012 and 31/12/2015. Sialadenitis was deemed present if there were any records of neck swelling/pain, dry mouth, or difficulty swallowing within 48 hours of RAI administration. Characteristics between patients with sialadenitis and those without were compared to determine predictors. Results. There were 174 patients admitted to receive RAI, predominantly females (71.3%), with papillary thyroid cancer (93.1%). The majority had lymph node involvement (64.5%). Pretreatment thyroid stimulating hormone (TSH) was greater than 75 mIU/ml in most patients (72.6%). The prevalence of sialadenitis was 20.1% (95% CI (15–27)). Being non-Lebanese and having a positive whole-body scan were associated with sialadenitis and persisted after adjustments (OR = 2.34 and 3.99). Non-Lebanese patients had higher rates of lymph nodes involvement (p value 0.005) and were kept off levothyroxine for longer periods (p value 0.02). Conclusion. The prevalence of sialadenitis at our institution was similar to other reported studies from the world. However, risk factors allude to more iodine exposure in the neck with positive whole-body scan uptake, lymph node involvement, and prolonged period of hypothyroidism.

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Section: Discussionmentioning

confidence: 99%

Early Sialadenitis After Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Prevalence and Predictors

Riachy

Ghazal

Haidar

et al. 2020

International Journal of Endocrinology

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“…In addition to these consequences, the conventional method has other drawbacks such as the long preparatory period (two weeks or longer) for diagnosis, persistent symptoms from hypothyroidism even after examination, and the risk of carcinoma cell growth. In contrast, the use of rhTSH has several advantages in terms of maintaining the QoL, shortening of the preparatory periods for diagnosis, avoiding hypothyroidism, having less chance of damage to the salivary gland [206], minimizing the stimulation of cancer cell growth [207,208], and alleviating radiation exposure by maintaining the renal function [209,210]. Adverse events associated with the use of rhTSH include headache, nausea, vomiting, general fatigue, and dizziness, although they are rare.…”

Section: Adverse Events Associated With Therapiesmentioning

confidence: 99%

The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer

Onoda²,

2020

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The Japan Associations of Endocrine Surgeons has developed the revised version of the Clinical Practice Guidelines for Thyroid Tumors. This article describes the guidelines translated into English for the 35 clinical questions relevant to the therapeutic management of thyroid cancers. The objective of the guidelines is to improve health-related outcomes in patients with thyroid tumors by enabling users to make their practice evidence-based and by minimizing any variations in clinical practice due to gaps in evidential knowledge among physicians. The guidelines give representative flowcharts on the management of papillary, follicular, medullary, and anaplastic thyroid carcinoma, along with recommendations for clinical questions by presenting evidence on the relevant outcomes including benefits, risks, and health conditions from patients' perspective. Therapeutic actions were recommended or not recommended either strongly (◎◎◎ or XXX) based on good evidence ( )/good expert consensus (+++), or weakly (◎, ◎◎ or X, XX) based on poor evidence ( )/poor expert consensus (+ or ++). Only 10 of the 51 recommendations given in the guidelines were supported by good evidence, whereas 35 were supported by good expert consensus. While implementing the current guidelines would be of help to achieve the objective, we need further clinical research to make our shared decision making to be more evidence-based.

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“…The severity of post-RAI xerostomia in DTC patients was assessed by the Xerostomia Inventory score (XI Score), the applicability of which has been validated in other studies (19,21). The English version of the XI Score was translated into a Chinese version for participants to conduct the questionnaire.…”

Section: Xerostomia Inventory Scorementioning

confidence: 99%

“…The XI Score's 11 options have a total score between 11 and 55 points. According to the size of the participants' XI total score, the participants were divided into three grades (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) points: no to mild xerostomia; 24-39 points: moderate to severe xerostomia; 40-55 points: severe to extreme xerostomia).…”

Section: Xerostomia Inventory Scorementioning

confidence: 99%

Alterations in Oral Microbiota of Differentiated Thyroid Carcinoma Patients With Xerostomia After Radioiodine Therapy

et al. 2022

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Background and AimsOral xerostomia remains one of the most common complications of differentiated thyroid carcinoma patients (DTC) after radioiodine therapy (RAI). Environmental factors in the etiology of xerostomia are largely unknown. We aimed to characterize the oral microbiota signatures and related biological functions associated with xerostomia and identify environmental factors affecting them.MethodsSaliva was collected from 30 DTC patients with xerostomia (XAs), 32 patients without xerostomia (indicated as non-XAs) following RAI after total thyroidectomy, and 40 healthy people (HCs) for 16S rRNA sequencing analysis.ResultsThe oral microbiota of XAs and non-XAs exhibited significant differences in α and β diversities and bacterial taxa. The abundance of porphyromonas, fusobacterium, and treponema_2 were significantly higher in XAs, while the abundance of the streptococcus was lower in the microbiota of non-XAs. Fusobacterium, and porphyromonas were negatively correlated with unstimulated/stimulated whole salivary secretion (USW)/(SWS), while fusobacterium, porphyromonas, and treponema_2 genera levels were positively associated with cumulative radioiodine dose. PICRUSt2 and BugBase suggested a significant difference in the expression of potentially_pathogenic, anaerobic, gram_negative, the arachidonic acid metabolism, and lipopolysaccharide (LPS) biosynthesis between XAs and non-XAs, possibly interdependent on radioiodine-induced inflammation. NetShift analysis revealed that porphyromonas genus might play as a key driver during the process of xerostomia. Five genera effectively distinguished XAs from non-XAs (AUC = 0.87).ConclusionOur study suggests for the first time that DTC patients with xerostomia after RAI display microbiota profiles and associated functional changes that may promote a pro-inflammatory environment. Dysbiosis of the oral microbiota may contribute to exacerbating the severity of xerostomia. Our results provide a research direction of the interaction mechanism between oral microbiota alteration and the progress of xerostomia.

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Effect of recombinant human thyroid‐stimulating hormone or levothyroxine withdrawal on salivary gland dysfunction after radioactive iodine administration for thyroid remnant ablation

Abstract: The use of rhTSH for preparation of radioactive iodine ablation as opposed to LT4 withdrawal reduces the incidence of salivary gland dysfunction. © 2015 Wiley Periodicals, Inc. Head Neck 38: E227-E230, 2016.

Cited by 14 publications

References 14 publications

Early Sialadenitis After Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Prevalence and Predictors

Early Sialadenitis After Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Prevalence and Predictors

The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer

Alterations in Oral Microbiota of Differentiated Thyroid Carcinoma Patients With Xerostomia After Radioiodine Therapy

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