1
|
Baudin C, Bressand A, Buffet C, Menegaux F, Soret M, Lê AT, Cardon T, Broggio D, Bassinet C, Huet C, Armengol G, Richardson DB, Leenhardt L, Bernier MO, Lussey-Lepoutre C. Dysfunction of the Salivary and Lacrimal Glands After Radioiodine Therapy for Thyroid Cancer: Results of the START Study After 6-Months of Follow-Up. Thyroid 2023; 33:1100-1109. [PMID: 37300484 DOI: 10.1089/thy.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background: Understanding of changes in salivary and lacrimal gland functions after radioactive iodine therapy (131I-therapy) remains limited, and, to date, no studies have evaluated dose-response relationships between absorbed dose from 131I-therapy and dysfunctions of these glands. This study investigates salivary/lacrimal dysfunctions in differentiated thyroid cancer (DTC) patients six months after 131I-therapy, identifies 131I-therapy-related risk factors for salivary/lacrimal dysfunctions, and assesses the relationships between 131I-therapy radiation dose and these dysfunctions. Methods: A cohort study was conducted involving 136 DTC patients treated by 131I-therapy of whom 44 and 92 patients received 1.1 and 3.7 GBq, respectively. Absorbed dose to the salivary glands was estimated using a dosimetric reconstruction method based on thermoluminescent dosimeter measurements. Salivary and lacrimal functions were assessed at baseline (T0, i.e., immediately before 131I-therapy) and six months later (T6) using validated questionnaires and salivary samplings, with and without stimulation of the salivary glands. Statistical analyses included descriptive analyses and random-effects multivariate logistic and linear regressions. Results: There was no difference between T0 and T6 in the level of parotid gland pain, nor was there difference in the number of patients with hyposalivation, but there were significantly more patients with dry mouth sensation and dry eyes after therapy compared with baseline. Age, menopause, depression and anxiety symptoms, history of systemic disease, and not taking painkillers in the past three months were found to be significantly associated with salivary or lacrimal disorders. Significant associations were found between 131I-exposure and salivary disorders adjusted on the previous variables: for example, per 1-Gy increase in mean dose to the salivary glands, odds ratio = 1.43 [CI 1.02 to 2.04] for dry mouth sensation, ß = -0.08 [CI -0.12 to -0.02] mL/min for stimulated saliva flow, and ß = 1.07 [CI 0.42 to 1.71] mmol/L for salivary potassium concentration. Conclusions: This study brings new knowledge on the relationship between the absorbed dose to the salivary glands from 131I-therapy and salivary/lacrimal dysfunctions in DTC patients six months after 131I-therapy. Despite the findings of some dysfunctions, the results do not show any obvious clinical disorders after the 131I-therapy. Nevertheless, this study raises awareness of the risk factors for salivary disorders, and calls for longer follow-up. Clinical Trials Registration: Number NCT04876287 on the public website (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Clémence Baudin
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | | | - Camille Buffet
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Fabrice Menegaux
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Department of General and Endocrine Surgery, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Marine Soret
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Biomedical Imaging Laboratory, CNRS, INSERM, Sorbonne University, Paris, France
| | - Anh Thu Lê
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Thomas Cardon
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - David Broggio
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Céline Bassinet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Christelle Huet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Gemma Armengol
- Department of Animal Biology, Plant Biology and Ecology, Faculty of Biosciences, Universitat Autònoma de Barcelona, Bellaterra, Catalonia, Spain
| | - David B Richardson
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laurence Leenhardt
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Marie-Odile Bernier
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Charlotte Lussey-Lepoutre
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Unit of Radionuclide Treatment, Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
| |
Collapse
|
2
|
Amini S, Golshani M, Moslehi M, Hajiahmadi S, Askari G, Iraj B, Bagherniya M. The effect of selenium supplementation on sonographic findings of salivary glands in papillary thyroid cancer (PTC) patients treated with radioactive iodine: study protocol for a double-blind, randomized, placebo-controlled clinical trial. Trials 2023; 24:501. [PMID: 37550760 PMCID: PMC10405508 DOI: 10.1186/s13063-023-07470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Thyroid cancer is a very damaging disease. The most common treatment for this disease includes thyroidectomy and then using radioactive iodine (RAI). RAI has many side effects, including a decrease in salivary secretions, followed by dry mouth and oral and dental injuries, as well as increased inflammation and oxidative stress. Selenium can be effective in these patients by improving inflammation and oxidative stress and by modulating salivary secretions. So far, only one clinical trial has investigated the effect of selenium on thyroid cancer patients treated with radioiodine therapy (RIT) conducted on 16 patients; considering the importance of this issue, to show the potential efficacy of selenium in these patients, more high-quality trials with a larger sample size are warranted. METHODS This is a parallel double-blind randomized controlled clinical trial that includes 60 patients aged 20 to 65 years with papillary thyroid cancer (PTC) treated with RAI and will be conducted in Seyyed al-Shohada Center, an academic center for referral of patients to receive iodine, Isfahan, Iran. Thirty patients will receive 200 µg of selenium for 10 days (3 days before to 6 days after RAI treatment) and another 30 patients will receive a placebo for the same period. Sonographic findings of major salivary glands, salivary secretions, and sense of taste will be evaluated before and 6 months after 10-day supplementation. DISCUSSION Due to its anti-inflammatory and antioxidant effects, as well as improving salivary secretions, selenium may improve the symptoms of thyroid cancer treated with radioactive iodine. In past studies, selenium consumption has not reduced the therapeutic effects of radiation therapy, and at a dose of 300 to 500 μg/day, it has not had any significant side effects in many types of cancer under radiation therapy. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20201129049534N6 . Registered on 16 September 2021.
Collapse
Affiliation(s)
- Sepide Amini
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Golshani
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Moslehi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Hajiahmadi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
3
|
Adramerinas M, Andreadis D, Vahtsevanos K, Poulopoulos A, Pazaitou-Panayiotou K. Sialadenitis as a complication of radioiodine therapy in patients with thyroid cancer: where do we stand? Hormones (Athens) 2021; 20:669-678. [PMID: 34143403 DOI: 10.1007/s42000-021-00304-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE This study aims to elaborate on the current knowledge concerning the mechanism, frequency, clinical manifestations, diagnostic procedures, prevention, and management of radioactive iodine (RAI)-induced sialadenitis in patients receiving treatment for differentiated thyroid cancer (DTC). METHODS A review of the literature was carried out through the " www.ncbi.nlm.nih.gov/pubmed " database focusing on the results of the past decade. RESULTS The high concentration of RAI in the salivary glands results in high beta radiation exposure of the striated duct cells and stem cells. This exposure leads to acute and/or chronic sialadenitis with obstructive symptoms and progressive loss of salivary gland function and xerostomia, with severe impact on patients' quality of life. No standard diagnostic method has been established. As far as prevention is concerned, many approaches have been proposed, such as sialogogues, local massage, vitamin E, and amifostine administration. Although there is no unanimity as to their effectiveness, the use of sialogogues is recommended. Treatment includes conservative drug therapy and sialendoscopy when necessary. CONCLUSION RAI-induced sialadenitis has a major impact on patients' quality of life. Due to the good prognosis of DTC, the reduction of sialadenitis and its prognosis, prevention, and treatment constitute a priority for the overall treatment of these patients. Further studies that will establish a coherent treatment protocol for this condition are necessary.
Collapse
Affiliation(s)
| | - Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Vahtsevanos
- Department of Oral/Maxillofacial Surgery, "G. Papanikolaou" Hospital of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Poulopoulos
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
5
|
Assessment and Care of Oral Lesions for Patients Who Undergo Radioiodine Treatment for Thyroid Cancer. Am J Med Sci 2020; 361:8-13. [PMID: 32950176 DOI: 10.1016/j.amjms.2020.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/23/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
Patients with differentiated thyroid cancer who undergo radioiodine treatment often present oral complications with a significant impact on their oral cavity function. Any potential sources of systemic infections like periodontal disease, unfitted dentures, orthodontic appliances, deficient/rough fillings, or traumatic dentition must be treated by the dental practitioner, because they represent the main source of spread and dissemination. Any systemic complication of a dental foci may result from improper dental preparation of the patient before radioiodine therapy and inadequate post-radioiodine therapy oral care. Therefore, all patients proceeding into radioiodine treatment should be addressed by the oncological team to undergo thorough dental check-up and receive appropriate treatment in due time.
Collapse
|
7
|
Wang H, Chen F, Zhang Y, Li Z, Wang Y, Li Q. [Three-dimensional reconstruction of cervical CT vs ultrasound for estimating residual thyroid volume]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:373-376. [PMID: 31068305 DOI: 10.12122/j.issn.1673-4254.2019.03.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the accuracy of three-dimensional reconstruction of cervical CT and ultrasound for estimating residual thyroid volume. METHODS We performed a retrospective analysis of 17 patients with 21 residual thyroid glands undergoing thyroidectomy surgery between February, 2017 and March, 2018 in our department. We compared the residual thyroid volume in preoperative ultrasound with the intraoperative measurement and the volume measured using threedimensional CT reconstruction before surgery. RESULTS The maximum vertical and anterioposterior diameters of the residual thyroid measured by preoperative ultrasound differed significantly from the volume data measured intraoperatively (P < 0.05), but the difference in the maximum left-right diameters was not statistically significant (P>0.05). The maximum vertical, leftright, and anteroposterior diameters estimated by three-dimensional reconstruction of cervical CT was all similar with those measured intraoperatively (P>0.05). CONCLUSIONS Compared with ultrasound examination, three-dimensional reconstruction of neck CT is more accurate for estimating the residual thyroid volume and provides more reliable evidence for clinical calculation of postoperative I131 dose for thyroid cancer.
Collapse
Affiliation(s)
- Hongjuan Wang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Fei Chen
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Yongquan Zhang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Zhichao Li
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Ying Wang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - Qiang Li
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| |
Collapse
|