Original articleSalivary Gland Toxicity after Radioiodine Therapy for Thyroid Cancer
Introduction
Clinicians treating patients with radioiodine (131I) are aware that the salivary glands have the ability to selectively take up and concentrate iodine. However, there seems to be little recognition of the potential for salivary gland toxicity, particularly when large doses of 131I are used, such as in the treatment of differentiated thyroid cancer (DTC). Soon after 131I therapy, patients may experience acute salivary gland swelling and pain, which usually subsides over a few days. Some patients will develop a slower onset of symptoms and others may progress to a chronic radiation sialadenitis. The frequency of these complications after 131I therapy is uncertain, but is probably clinically significant in 11%–30% of patients 1, 2. We report our experience of salivary gland toxicity in order to highlight these problems and emphasise the importance of early recognition to minimise morbidity.
Section snippets
Materials and Methods
We carried out a prospective cohort study of all patients with DTC treated with 131I at the Royal Marsden Hospital over a 12-month period. There were 76 patients in this cohort and they were followed for a minimum of 48 months. All patients underwent total or near-total thyroidectomy before 131I ablation. An ablative dose of 3 GBq was given 4–6 weeks after surgery and a further therapy dose of 5.5 GBq was given if residual disease was demonstrated by abnormal post-ablative 131I whole body scans
Results
The cohort of 76 patients undergoing 131I ablation consisted of 19 men and 57 women, mean age 50.9 years (range 17–89). Fifty-six patients had papillary cancer, 18 had follicular cancer and two had Hürthle cell cancer. Lymph node metastases were present in 29 patients and eight had distant metastases. Twenty patients (26%) developed salivary gland toxicity with a median time of onset of 48 h from the timing of the 131I dose. The median duration of toxicity symptoms was 12 months. In the 11
Discussion
The overall frequency of symptomatic salivary gland damage after 131I in this study is 26% keeping with that reported previously 1, 2. Unusually, in this series, the submandibular glands seemed to be most frequently affected, although it was noticeable that the parotids were principally affected in all five patients in the cohort with chronic persistent swelling. It is possible that submandibular salivary gland involvement is under-reported and that swelling in these glands is confused with
Conclusion
In summary, clinicians, as well as patients receiving 131I, need to be aware of the possibility of salivary gland toxicity. Patients should be warned of the possibility of a dry mouth, pain or swelling in the salivary glands and told to report any symptoms to their nurse or doctor during their admission or at follow-up visits. Although in most cases this is a transient side-effect, it may persist for months or appear as a late complication. Early recognition is important so that further damage
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