Long-term effects of radioiodine treatment on salivary gland function in adult survivors of pediatric differentiated thyroid carcinoma

• Published in: Journal of Nuclear Medicine Vol. 60; no. 2; pp. 172 - 177
• Main Authors: Selvakumar, Tharsana, Nies, Marloes, Klein Hesselink, Mariëlle S, Brouwers, Adrienne H, van der Horst-Schrivers, Anouk N A, Klein Hesselink, Esther N, Tissing, Wim J E, Vissink, Arjan, Links, Thera P, Bocca, G, Burgerhof, J G M, van Dam, E W C M, Havekes, B, van den Heuvel-Eibrink, M M, Corssmit, E P M, Kremer, L C M, Netea-Maier, R T, van der Pal, H J H, Peeters, R P, Smit, J W A, Plukker, J T M, Ronckers, C M, van Santen, H M
• Format: Journal Article
• Language: English
• Published: United States Society of Nuclear Medicine 01.02.2019
• Subjects: Adults; Children; Evaluation; Iodine 131; Iodine radioisotopes; Long-term effects; Medical treatment; Patients; Pediatrics; Proteins; Rare diseases; Saliva; Salivary gland; Salivary glands; Secretion; Survival; Thyroid; Thyroid cancer; Thyroid carcinoma; Thyroidectomy; Xerostomia; Pediatrics; Oncology: Endocrine; Endocrine; pediatric differentiated thyroid carcinoma; xerostomia; radioiodine treatment; salivary gland dysfunction
• ISSN: 0161-5505; 1535-5667; 2159-662X
• DOI: 10.2967/jnumed.118.212449

Pediatric differentiated thyroid cancer (DTC) is a rare disease. Initial treatment of DTC consists of a (near) total thyroidectomy and radioactive iodine ( I) therapy. Previous studies in adults showed that I treatment may result in a reduced salivary gland function. Studies regarding salivary gland function in children treated for DTC are sparse. Our aim was to assess long-term effects of I treatment on salivary gland function in survivors of pediatric DTC. In a nationwide cross-sectional study, salivary gland function of patients treated for pediatric DTC between 1970 and 2013 (>5 years after diagnosis, ≥18 years old at time of evaluation) was studied. Salivary gland function was assessed by sialometry, sialochemistry and a xerostomia inventory. Salivary gland dysfunction was defined as unstimulated whole saliva flow ≤0.2mL/min and/or a stimulated whole saliva flow ≤0.7 mL/min. Sixty-five patients (median age at evaluation 33 [IQR, 25-40] years, 86.2% female, median follow-up period 11 [IQR, 6-22] years) underwent I treatment. Median cumulative I activity was 5.88 [IQR, 2.92-12.95] GBq, 47.7% underwent multiple I administrations. Salivary gland dysfunction was present in 30 (47.6%) patients. Levels of amylase and total protein in saliva were reduced. Moderate to severe xerostomia was present in 22 (35.5%) patients. Stimulated salivary secretion was lower and severity of xerostomia complaints higher in patients treated with higher cumulative I activity. In survivors of pediatric DTC, clinically significant salivary gland dysfunction was found in 35.5% and was related to the cumulative I activity of the treatment.