131 I ablation therapy for patients with differentiated thyroid cancer commonly leads to radiation sialadenitis. Our findings show that 131 I severely impaired the ultrastructure and the functions of mitochondria in submandibular glands, and the mitochondria-related SIRT1/NAMPT/PGC-1a signal pathways were involved in this process, indicating that 131 I radiation interrupted the mitochondrial homeostasis. Phenylephrine provided cytoprotection against 131 I at the mitochondrial level, suggesting that Purpose: The impairment of the salivary glands is a permanent side effect of 131 I ablation therapy for patients with differentiated thyroid cancer. Effective and safe treatments for protecting the salivary glands against 131 I are currently not available. Mitochondria are susceptible to ionizing radiation, but alterations after 131 I exposure are unknown. Here, we investigated the mechanisms of 131 I damage in submandibular glands (SMGs) and evaluated the cytoprotective effect of phenylephrine (PE) against mitochondrial radiation damage. Methods and Materials: Rats were randomly divided into 4 groups: control, PE alone, 131 I alone, and 131 I with PE pretreatment. The mitochondrial structure of SMGs was observed under transmission electron microscopy. Apoptosis was detected using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling. Cytochrome c, cleaved-caspase 3, SIRT1, NAMPT, and PGC-1a protein levels were determined with Western blot and immunohistochemistry. Levels of mitochondrial membrane potential, nicotinamide adenine dinucleotide (NAD), and adenosine triphosphate (ATP) were measured with relevant kits. Results: After exposing rat SMGs to 131 I, the mitochondrial membrane structures were destroyed, the mitochondrial membrane potential decreased, the release of cytochrome c increased, and cleaved-caspase 3 and cell apoptosis were activated. Moreover, the expression of SIRT1, NAMPT, and PGC-1a was downregulated, and the levels of NAD and ATP decreased. In contrast, PE alleviated the 131 I-induced