The Role of Radioactive Iodine in Salivary Gland Dysfunction

Newkirk, Kenneth; Ringel, Matthew D.; Wartofsky, Léonard; Burman, Kenneth D.

doi:10.1177/014556130007900612

Cited by 54 publications

(41 citation statements)

References 36 publications

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“…In confirmation of other studies, we show that there is a lesser effect of RAI therapy on submandibular functioning (4, 6, 10). The greater impact of ionizing radiation on the parotid glands is thought to due to their greater activity and greater content of serous cells, compared with the mixed serous and mucinous cell content of the submandibular glands (6).…”

Section: Discussionsupporting

confidence: 92%

“…Consequently, salivary glands have the ability to specifically concentrate iodine (1, 4), although its physiological role is not as yet elucidated. Salivary gland dysfunction after RAI treatment occurs quite frequently, even with a first therapy or low-dose therapy (5, 6).…”

Section: Introductionmentioning

confidence: 99%

“…More damage also seems to occur with treatment protocols involving withdrawal from thyroid hormone than with recombinant human thyrotropin (rhTSH) protocols (5). The parotid glands appear to suffer damage more frequently than the submandibular glands (4, 6, 10). Salivary gland dysfunction can present as sialadenitis, xerostomia, taste alterations, hypogeusia, sialolithiasis, dental caries, stomatitis, salivary gland or oral infections, facial nerve damage, and even salivary gland neoplasia (6, 9).…”

Section: Introductionmentioning

confidence: 99%

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Salivary Function after Radioiodine Therapy: Poor Correlation between Symptoms and Salivary Scintigraphy

2015

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ObjectiveSymptoms of salivary gland dysfunction frequently develop after radioactive iodine (RAI) therapy, but have generally not been correlated with assessment of salivary gland functioning. The aim of this study was to determine whether there was a correlation between salivary symptoms and salivary functioning as assessed by salivary scan parameters.MethodsThis was a non-randomized observational study. Fifteen patients receiving RAI therapy for differentiated thyroid cancer completed a questionnaire assessing their salivary and nasal symptoms prior to their therapy and 3 and 12 months after their therapy. Salivary gland scanning using technetium-99m pertechnetate was performed at the same time points. In addition, protective measures used at the time of radioiodine administration, such as use of fluids and sour candy, were also documented. Measures of salivary gland accumulation and secretion were correlated with scores of salivary and nasal symptomatology and any effects of protective measures were assessed.ResultsThe mean number of salivary, nasal, and total symptoms at 3 months increased significantly over the number of symptoms at baseline by 3.7, 2.7, and 6.3 symptoms, respectively (p values 0.001, 0.0046, and <0.001, respectively). The mean increases in the number of salivary, nasal, and total symptoms at 12 months were non-significant at 1.3, 1.3, and 2.5 symptoms, respectively. The mean right parotid gland accumulation and secretion of radioisotope declined significantly at 3 months, compared with baseline. The changes in left parotid and right and left submandibular function were non-significant. There was no association between the increase in salivary, nasal, or total symptoms and the change in scintigraphy measures. However, the increases in nasal and total symptoms were significantly greater in those with co-existent Hashimoto’s disease, compared with those without this condition (p values 0.01 and 0.04, respectively). Nasal symptoms decreased (p value 0.04) and total symptoms trended to decrease (p value 0.08) in those who used sour candies, compared with those who did not. Increasing body mass index was significantly associated with increasing nasal symptoms (p value 0.05). Greater decline in salivary parameters at 3 months compared with baseline was generally associated with heavier body weight, decreased thyroid cancer stage, absence of Hashimoto’s thyroiditis, and pre-menopausal status.ConclusionSalivary and nasal symptoms increased and salivary scintigraphy parameters decreased after radioiodine therapy. However, the increased symptoms did not correlate with decrements in salivary gland accumulation or secretion. Moreover, the variables associated with symptoms and changes in salivary scan parameters differed. Therefore, a better understanding of the relationship between salivary gland symptoms and functioning is needed. Factors affecting susceptibility to salivary and nasal damage after radioiodine therapy need to be better elucidated, so that modifiable factors can be identified.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Salivary Function after Radioiodine Therapy: Poor Correlation between Symptoms and Salivary Scintigraphy

2015

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“…Later, diminished TPT uptake results from vascular fibrosis caused by the destructive effect of the 131 I and becomes manifest slowly over a prolonged period. Several studies using salivary gland scintigraphy have revealed that dosages of 18,500 MBq (500 mCi) caused abnormal salivary gland function in as many as 80% of the patients [26] and approached 100% when more was used [27][28][29]. Several reports revealed good correlation between subjective symptoms and objective findings of salivary gland scintigraphy [30][31][32].…”

Section: Early and Late Sialadenitismentioning

confidence: 99%

RETRACTED ARTICLE: Radiation Sialadenitis Induced by High-dose Radioactive Iodine Therapy

Jeong

Lee

2010

Nucl Med Mol Imaging

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Radioactive iodine ((131)I) is accumulated in the thyroid tissue and plays an important role in the treatment of differentiated papillary and follicular cancers after thyroidectomy. Simultaneously, (131)I is concentrated in the salivary glands and secreted into the saliva. Dose-related damage to the salivary parenchyma results from the (131)I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of (131)I and/or months later and progress in intensity with time. In conjunction with the radiation sialadenitis, secondary complications reported include xerostomia, taste alterations, infection, increases in caries, facial nerve involvement, candidiasis, and neoplasia. Prevention of (131)I sialadenitis may involve the use of sialogogic agents to hasten the transit time of the radioactive iodine through the salivary glands. However, studies are not available to delineate the efficacy of this approach. Treatment of the varied complications that may develop encompass numerous approaches and include gland massage, sialogogic agents, duct probing, antibiotics, mouthwashes, good oral hygiene, and adequate hydration. Recently interventional sialoendoscopy has been introduced an effective tool for the management of patients with (131)I-induced sialadenitis that is unresponsive to medical treatment.

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“…More damage seems to occur with treatment protocols involving withdrawal from thyroid hormone than with rhTSH protocols (21). The parotid glands suffer damage more frequently than the submandibular glands (3,20,22). Salivary gland dysfunction can be manifest as sialadenitis, xerostomia, taste alterations, hypogeusia, and sialolithiasis.…”

Section: Discussionmentioning

confidence: 99%

Nasal Symptoms After Radioiodine Therapy: A Rarely Described Side Effect with Similar Frequency to Lacrimal Dysfunction

Jonklaas

2014

Thyroid

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The Role of Radioactive Iodine in Salivary Gland Dysfunction

Cited by 54 publications

References 36 publications

Salivary Function after Radioiodine Therapy: Poor Correlation between Symptoms and Salivary Scintigraphy

Salivary Function after Radioiodine Therapy: Poor Correlation between Symptoms and Salivary Scintigraphy

RETRACTED ARTICLE: Radiation Sialadenitis Induced by High-dose Radioactive Iodine Therapy

Nasal Symptoms After Radioiodine Therapy: A Rarely Described Side Effect with Similar Frequency to Lacrimal Dysfunction

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