Solans R, Bosch J A, Galofré P, Porta F, Roselló J, Selva-O'Callagan A, Vilardell M
Department of Internal Medicine, Vall d'Hebron General Teaching Hospital, Barcelona, Spain.
J Nucl Med. 2001 May;42(5):738-43.
Salivary gland dysfunction has been described in patients undergoing radioiodine therapy but associated lacrimal gland dysfunction (sicca syndrome) has never been reported. We conducted a prospective cohort study with follow-up for up to 3 y in a tertiary care university center to determine the prevalence of sicca syndrome in patients after high-dose radioiodine treatment.
From January 1990 to December 1995, all patients undergoing radioiodine therapy (n = 79) with a standard dose of 925 MBq to 18.5 GBq (25-500 mCi) were interviewed using a standardized questionnaire to determine subjective ocular and oral dryness and were examined for objective lacrimal and salivary gland dysfunction.
After radioiodine treatment, 32.9% of the patients reported subjective xerostomia and 25.3% reported subjective xerophthalmia in the first year of follow-up. Xerostomia persisted to the second year of follow-up in 20.3% of cases and was still present >3 y after the last dose of radioiodine in 15.2% of cases. Xerophthalmia persisted to the second year of follow-up in 17.7% of cases and was still present in the third year of follow-up in 13.9% of cases. Severe xerostomia occurred in 4 patients. Reduced salivary and lacrimal gland function was documented in 40 (50.6%) and 14 (17.7%) of the 79 cases, respectively, in the first year of follow-up. Objective xerostomia persisted in 13.9% of cases to the second year of follow-up and was still present in all patients >3 y after the last radioiodine application. Keratoconjunctivitis sicca persisted in 11 patients (13.9%) to the second year of follow-up but was only present in 6 patients (7.6%) >3 y after the last radioiodine application. Additionally, 28/79 patients (35.4%) who had a normal salivary gland scintigraphy previously showed reduced salivary gland function in the third year of follow-up. No significant dependence on cumulative treatment was found for objective xerostomia or xerophthalmia, but doses >11.1 GBq (300 mCi) were related to stage 3 dysfunction on salivary gland scintigraphy.
Salivary and lacrimal gland dysfunction (sicca syndrome) is relatively frequent after radioiodine therapy. In most cases this is a transient side effect, but in some patients it may persist for a long period or appear late.
放射性碘治疗的患者中已出现唾液腺功能障碍，但与之相关的泪腺功能障碍（干燥综合征）从未被报道过。我们在一所三级医疗大学中心进行了一项前瞻性队列研究，随访时间长达3年，以确定高剂量放射性碘治疗后患者中干燥综合征的患病率。
1990年1月至1995年12月，所有接受标准剂量925MBq至18.5GBq（25 - 500mCi）放射性碘治疗的患者（n = 79）均使用标准化问卷进行访谈，以确定主观眼干和口干情况，并检查客观泪腺和唾液腺功能障碍。
放射性碘治疗后，32.9%的患者在随访的第一年报告有主观口干，25.3%的患者报告有主观眼干。20.3%的病例口干持续到随访的第二年，15.2%的病例在最后一剂放射性碘治疗后3年以上仍存在口干。17.7%的病例眼干持续到随访的第二年，13.9%的病例在随访的第三年仍存在眼干。4例患者出现严重口干。79例患者中，分别有40例（50.6%）和14例（17.7%）在随访的第一年记录有唾液腺和泪腺功能减退。客观口干在13.9%的病例中持续到随访的第二年，在最后一次放射性碘治疗后3年以上所有患者中仍存在。干燥性角结膜炎在11例患者（13.9%）中持续到随访的第二年，但在最后一次放射性碘治疗后3年以上仅6例患者（7.6%）存在。此外，28/79例（35.4%）先前唾液腺闪烁显像正常的患者在随访的第三年显示唾液腺功能减退。未发现客观口干或眼干与累积治疗有显著相关性，但剂量>11.1GBq（300mCi）与唾液腺闪烁显像的3期功能障碍有关。
放射性碘治疗后唾液腺和泪腺功能障碍（干燥综合征）较为常见。在大多数情况下，这是一种短暂的副作用，但在一些患者中可能会长期持续或延迟出现。
