Radioactive iodine and the salivary glands.
Radioactive iodine ((131)I) 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 (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, stomatitis, candidiasis, and neoplasia. Prevention of the (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. 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.
Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Medical School, Philadelphia, Pennsylvania 19104, USA. smandel@mail.med.upenn.edu
Susan J
SJ
Mandel
Louis
L
Mandel
D004999:Amifostine / Q000627:therapeutic use; D002291:Carcinoma, Papillary / Q000532:radiotherapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D011837:Radiation-Protective Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D011877:Radionuclide Imaging; D012466:Salivary Gland Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D012469:Salivary Glands / Q000000981:diagnostic imaging / Q000528:radiation effects*; D013670:Sodium Pertechnetate Tc 99m / Q000493:pharmacokinetics; D013964:Thyroid Neoplasms / Q000532:radiotherapy
D007457:Iodine Radioisotopes; D011837:Radiation-Protective Agents; D013670:Sodium Pertechnetate Tc 99m; D004999:Amifostine