Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
J Nucl Med. 2016 Nov;57(11):1685-1691. doi: 10.2967/jnumed.115.169888. Epub 2016 Jun 23.
Complaints of a dry mouth (xerostomia) and sialoadenitis are frequent side effects of radioiodine treatment in differentiated thyroid cancer (DTC) patients. However, detailed prospective data on alterations in salivary gland functioning after radioiodine treatment (I) are scarce. Therefore, the primary aim of this study was to prospectively assess the effect of high-activity radioiodine treatment on stimulated whole saliva flow rate. Secondary aims were to study unstimulated whole and stimulated glandular (i.e., parotid and submandibular) saliva flow rate and composition alterations, development of xerostomia, characteristics of patients at risk for salivary gland dysfunction, and whether radioiodine uptake in salivary glands on diagnostic scans correlates to flow rate alterations.
In a multicenter prospective study, whole and glandular saliva were collected both before and 5 mo after radioiodine treatment. Furthermore, patients completed the validated xerostomia inventory. Alterations in salivary flow rate, composition, and xerostomia inventory score were analyzed. Salivary gland radioiodine uptake on diagnostic scans was correlated with saliva flow rate changes after radioiodine treatment.
Sixty-seven patients (mean age ± SD, 48 ± 17 y; 63% women, 84% underwent ablation therapy) completed both study visits. Stimulated whole saliva flow rate decreased after ablation therapy (from 0.92 [interquartile range, 0.74-1.25] to 0.80 [interquartile range, 0.58-1.18] mL/min, P = 0.003), as well as unstimulated whole- and stimulated glandular flow rates (P < 0.05). The concentration of salivary electrolytes was similar at both study visits, whereas the output of proteins, especially amylase (P < 0.05), was decreased. The subjective feeling of dry mouth increased (P = 0.001). Alterations in saliva flow rate were not associated with semiquantitatively assessed radioiodine uptake in salivary glands on diagnostic scans. For the small cohort of patients undergoing repeated radioiodine therapy, we could not demonstrate alterations in salivary parameters.
We prospectively showed that salivary gland function is affected after high-activity radioiodine ablation therapy in patients with DTC. Therefore, more emphasis should be placed on salivary gland dysfunction during follow-up for DTC patients receiving high-activity radioiodine treatment.
本研究旨在前瞻性评估高活度放射性碘治疗对刺激全唾液流量的影响。次要目的是研究未刺激全唾液和刺激腺（即腮腺和颌下腺）唾液流量和成分变化、口干的发展、唾液腺功能障碍风险患者的特征，以及唾液腺放射性碘摄取在诊断性扫描与流量变化的相关性。
在一项多中心前瞻性研究中，在放射性碘治疗前后 5 个月收集全唾液和腺唾液。此外，患者完成了验证过的口干量表。分析唾液流量、成分和口干量表评分的变化。将唾液腺放射性碘摄取与放射性碘治疗后唾液流量变化相关联。
67 例患者（平均年龄 ± 标准差，48 ± 17 岁；63%为女性，84%行消融治疗）完成了两次研究访问。消融治疗后刺激全唾液流量下降（从 0.92 [四分位距，0.74-1.25]降至 0.80 [四分位距，0.58-1.18] mL/min，P = 0.003），未刺激全唾液和刺激腺唾液流量也下降（P < 0.05）。两次研究访问时唾液电解质浓度相似，但蛋白质，尤其是淀粉酶的分泌量减少（P < 0.05）。口干的主观感觉增加（P = 0.001）。唾液流量的变化与诊断性扫描中唾液腺半定量评估的放射性碘摄取无关。对于接受重复放射性碘治疗的小患者队列，我们无法证明唾液参数的变化。
我们前瞻性地表明，DTC 患者接受高活度放射性碘消融治疗后，唾液腺功能受到影响。因此，在随访接受高活度放射性碘治疗的 DTC 患者时，应更加重视唾液腺功能障碍。
