RETRACTED ARTICLE: Radiation Sialadenitis Induced by High-dose Radioactive Iodine Therapy

Abstract

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.

Sialendoscopy for Patients with Radioiodine-Induced Sialadenitis and Xerostomia

“…Early and late sialadenitis occurs most frequently (2). Approximately 10%-60% of patients treated with RAI report acute or chronic salivary dysfunction related symptoms (3)(4)(5)(6)(7). Symptoms of sialadenitis include pain and swelling of the affected glands, trismus, sour taste in the mouth, and facial weakness.…”

An evaluation of the radioprotective effect of vitamin E on the salivary glands of radioactive iodine in rats

“…[1] Bu nedenle RAİ tedavisi tirotoksikozlu hastalarda ve cerrahi sonrasında diferansiye tiroid kanserli hastalarda hiperfonksiyone tiroid dokusunun, tiroid doku artığının, bölgesel veya uzak tümör dokularının yok edilmesinde önemli bir tedavi seçeneğidir. [2][3][4] Eksternal radyasyon ve RAİ tedavisi serbest radikal üretimine neden olarak hücresel zedelenmeye yol açar. [5] Radyoaktif iyot tedavisinin oksidatif strese yol açtığı dolayısıyla lipidler, proteinler ve deoksiribonükleik asit (DNA) gibi hücresel yapılara önemli ölçüde zarar verdiği bilinir.…”

“…Tükürük bezlerinde radyasyona bağlı hasar RAİ tedavisinin en yaygın komplikasyonlarından biridir. [4] Tükürük bezi yan etkileri RAİ tedavisi uygulanan tiroid kanserli hastalarda morbiditenin kaynağı olabilir. [2] Radyoaktif iyot tedavisi sonrasında tükürük bezleri üzerinde radyasyondan koruyucu etkinliği olabilen bir ajanın kullanılması hastanın yaşam kalitesini yükseltecektir.…”

Effect of Parotid Gland Massage on Parotid Gland Tc-99m pertechnetate Uptake

“…The administration of sialagogues, such as, lemon juice or lemon candy, may help prevent salivary damage after the 131 I therapy, but this strategy is known to inadequately protect salivary gland function (7)(8)(9). Of the salivary glands, the parotid gland (PG) most frequently produces symptoms after 131 I therapy, and is known to be more radiosensitive than the submandibular salivary gland (10). External massage of the PG is presumed to be helpful in preventing parotid dysfunction after 131 I therapy (3,(11)(12)(13), because it is believed to ''milk out'' accumulated 131 I into the oral cavity, and thus, reduce radiation risks.…”