Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer?
Salivary gland dysfunction is one of the common side effects of high-dose radioiodine therapy for thyroid cancer. The purpose of this study was to determine whether an early start of sucking lemon candy decreases salivary gland injury after radioiodine therapy.


METHODS
The incidence of the side effects of radioiodine therapy on the salivary glands was prospectively and longitudinally investigated in 2 groups of patients with postsurgical differentiated thyroid cancer with varying regimens for sucking lemon candy. From August 1999 to October 2000, 116 consecutive patients were asked to suck 1 or 2 lemon candies every 2-3 h in the daytime of the first 5 d after radioiodine therapy (group A). Lemon candy sucking was started within 1 h after radioiodine ingestion. From November 2000 to June 2002, 139 consecutive patients (group B) were asked to suck lemon candies in a manner similar to that of group A. In the group B, lemon candies were withheld until 24 h after the ingestion of radioiodine. Patients with salivary gland disorders, diabetes, collagen tissue diseases, or a previous history of radioiodine therapy or external irradiation to the neck were excluded. Thus, 105 patients in group A and 125 patients in group B were available for analysis. There were no statistical differences in the mean age (55.2 y vs. 58.5 y), average levels of serum free thyroxine (l-3,5,3',5'-tetraiodothyronine) (0.40 ng/dL vs. 0.47 ng/dL), and the mean dose of (131)I administered (3.96 GBq vs. 3.87 GBq) between the 2 groups. The onset of salivary side effects was monitored during hospital admission and regular follow-up on the basis of interviews with patients, a visual analog scale, and salivary gland scintigraphy using (99m)Tc-pertechnetate. When a patient showed a persistent (>4 mo) dry mouth associated with a nonfunctioning pattern on salivary gland scintigraphy, a diagnosis of xerostomia was established.


RESULTS
The incidences of sialoadenitis, hypogeusia or taste loss, and dry mouth with or without repeated sialadenitis in group A versus group B were 63.8% versus 36.8% (P < 0.001), 39.0% versus 25.6% (P < 0.01), and 23.8% versus 11.2% (P < 0.005), respectively. Permanent xerostomia occurred in 15 patients in group A (14.3%) and 7 patients in group B (5.6%) (P < 0.05). In both groups, bilateral involvement of the parotid gland was the most frequently seen and was followed by bilateral involvement of the submandibular gland.


CONCLUSIONS
An early start of sucking lemon candy may induce a significant increase in salivary gland damage. Lemon candy should not be given until 24 h after radioiodine therapy.
Nakada
Kunihiro
K
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8636, Japan. metnakada@yahoo.co.jp
Ishibashi
Tetsuya
T
Takei
Toshiki
T
Hirata
Kenji
K
Shinohara
Katsura
K
Katoh
Seiichi
S
Zhao
Sonji
S
Tamaki
Nagara
N
Noguchi
Yasushi
Y
Noguchi
Shiro
S
D000284:Administration, Oral; D002182:Candy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000008:administration & dosage*; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use; D012466:Salivary Gland Diseases / Q000209:etiology* / Q000517:prevention & control*; D012469:Salivary Glands / Q000187:drug effects / Q000528:radiation effects; D012472:Salivation / Q000187:drug effects; D013964:Thyroid Neoplasms / Q000532:radiotherapy*; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D011837:Radiation-Protective Agents; D019275:Radiopharmaceuticals