Seeking optimal management for radioactive iodine therapy-induced adverse effects

Abstract

Radioactive iodine therapy (RAIT) is one of the important treatment modalities in the management of differentiated thyroid cancer (DTC). RAIT with iodine-131 has long been used in the management of DTC for the ablation of residual thyroid or treatment of its metastases. Despite being reasonably safe, radioiodine therapy is not always without side effects. Even relatively low administered activities of RAIT used for remnant ablation have been associated with the more clinically significant side effects of sialadenitis, xerostomia, salivary gland pain and swelling, dry eyes, excessive tearing, or alterations in taste in as many as 25% of patients. Given that there is a lack of comprehensive management of these RAIT-induced adverse effects, this paper explores the use of other nonpharmacological measures and their effectiveness as interventions to minimize salivary gland damage.

Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy in Patients with Multinodular Goiters: A Meta-Analysis of Randomized Controlled Trials

“…It is reported that 131 I therapy can result in a mean thyroid volume reduction ranging from 40-60 % within 1-2 years after treatment [8]. However, many physicians are still reluctant to choose this therapeutic method [20,21]. Because MNG is often large, and frequently corresponding RAIU is low resulting in a relatively low 131 I activity, which is not good for satisfactory goiter shrinkage [22].…”

A pretest–posttest pilot study for the development and preliminary validation of a tool for the clinical assessment of radioiodine induced sialadenitis

“…Severe sialadenitis symptoms may intervene with patients’ therapy when not timely treated. 22 The SAT consists of 4 grades, staging from 0 to 3, and can guide the escalation of treatment. In particular, Grade 0 could be treated with preventive measures, namely, hydration and sialagogues, such as lemon candy, lemon juice, lemon slices, Vitamin C, and Vitamin E. 23–26 Grade 1 could be treated with the above preventive measures, with the addition of local ice therapy for cases of sensitivity, 23 whereas Grade 2 patients could benefit from the use of the aforementioned measures and the use of cholinergic agents.…”

Anxiety and depression status prior to radioactive iodine therapy among differentiated thyroid cancer patients during the COVID‑19 epidemic

“…The PHQ-9 scale, a nine-item questionnaire in each item scored 0-3, with good reliability and validity, was performed to re ect the severity of depression symptoms. The total scores of GAD-7 and PHQ-9 were categorized as follows: GAD-7, no anxiety (0-4), mild anxiety (5-9), moderate anxiety (10)(11)(12)(13)(14), and severe anxiety (15)(16)(17)(18)(19)(20)(21); and PHQ-9, no depression (0-4), mild depression (5-9), moderate depression (10)(11)(12)(13)(14), and severe depression (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

“…Post-surgical radioactive iodine (RAI) therapy is one crucial and effective treatment for reducing the risk of recurrence and even the mortality of differentiated thyroid cancer (DTC) patients(18-20). Notably, DTC patients with RAI therapy probably experience physical symptoms (such as loss of appetite, fatigue, nausea, and neck pain) (21), in addition to might occurring various emotional symptoms in response (such as anxiety, depression, and uncertainty)(16). Moreover, there are other adverse effects of RAI therapy, such as salivary gland dysfunction and inducing secondary primary malignancies (22).…”