Radioactive Iodine and the Salivary Glands

Susan J. Mandel, Louis Mandel

Disclosures

Thyroid. 2003;13(3) 

In This Article

Abstract and Introduction

Radioactive iodine (131I) targets the thyroid gland and has been proven to play an effective role in the treatment of differentiated papillary and follicular cancers. Simultaneously, this radioisotope hones in on the salivary glands where it is concentrated and secreted into the saliva. Dose related damage to the salivary parenchyma results from the 131I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of 131I 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, stomatitis, candidiasis, and neoplasia. Prevention of the 131I 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. Recently, amifostine has been advocated to prevent the effects of irradiation. 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.

Radiation damage to the salivary glands is a known short-term and long-term complication of radioactive iodine (131I) therapy for patients with differentiated thyroid cancer.[1,2,3,4] This morbid aspect of 131I therapy has caused significant patient distress and warrants measures designed to circumvent this commonly experienced salivary gland impairment. Consequently, the purpose of this review paper is to further focus attention on the problem. Emphasis is placed on the mechanisms involved in the evolution of the sialadenitis and the therapeutic steps that can be taken to inhibit or limit its onset, or treat the condition if it develops.

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