Download PDF
Ultraschall Med
DOI: 10.1055/a-2190-6751
Original Article

Ultrasound Changes in Salivary Glands after Radioactive Iodine Treatment in Benign Diseases and Differentiated Cancer of Thyroid Glands in Consideration of Dose and Time Dependency

Ultraschallbefunde bei Speicheldrüsen nach Radiojod-Therapie von gutartigen Schilddrüsen-Erkrankungen und differenzierten Schilddrüsen-Karzinomen unter Berücksichtigung von Dosis- und Zeiteffekten
Michael Koch 
1   Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN27168)
,
Vanessa Fauck
2   ENT, Head and Neck Surgery, Nuremberg Hospital Campus North, Nurnberg, Germany (Ringgold ID: RIN9211)
,
Matti Sievert
1   Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN27168)
,
Konstantinos Mantsopoulos
1   Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN27168)
,
Heinrich Iro
1   Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN27168)
,
Sarina Mueller
1   Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany (Ringgold ID: RIN27168)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Purpose To assess ultrasound (US) features observed in salivary glands after radioactive iodine treatment (RAIT) in relation to the dose and time interval after RAIT.

Materials and Methods A retrospective analysis of US findings regarding the salivary glands of patients presenting after RAIT due to thyroid cancer (Group 1, n=99) or benign thyroid diseases (Group 2, n=25). The control group consisted of randomly selected patients (no RAIT, Group 3, n=100). Groups were compared regarding RAIT dose, symptoms, and US findings (duct dilation, hypoechoic/heterogeneous parenchyma, parenchymal loss). The association of the presence of US parameters after RAIT with various dose levels (2000–15000MBq) and time intervals (24, 60, 120 months) and the differences between the groups was evaluated.

Results Significant differences between US parameters were noted when comparing Group 1 with Group 2 or 3. Nothing of relevant significance was noted when Groups 2 and 3 were compared. US features indicating a slight or moderate sialadenitis showed the most significant associations with doses <4000MBq and time intervals <24 months after RAIT. US changes indicating a serious sialadenitis or even gland atrophy showed the most significant association at doses between >7000–9000MBq and when US was performed >60 months after RAIT.

Conclusion Our results point to a dose and time dependency of pathologic US findings in RAIT-induced effects on the major salivary glands. Based on the US findings, a better estimation of the current impact of RAIT on the salivary glands and the further prognosis appears possible.

Zusammenfassung

Ziel Analyse von Befunden im Ultraschall (US) bei Speicheldrüsen nach Radiojod-Therapie (RJT) in Abhängigkeit von der Dosis und dem Zeitintervall nach RJT.

Material und Methoden Retrospektive Analyse von US-Befunden von Speicheldrüsen bei Patienten nach RJT wegen Karzinomen (Gruppe 1, n=99) oder benignen Erkrankungen (Gruppe 2, n=25) der Schilddrüse. Die Kontrollgruppe bestand aus zufällig selektierten Patienten (keine RJT, Gruppe 3, n=100). Die Gruppen wurden hinsichtlich der RJT-Dosis, der Frequenz von Symptomen und US-Befunden verglichen. Die Häufigkeit von US-Parametern in Abhängigkeit von verschiedenen RJT-Dosen (2000–15000MBq) und Zeitintervallen nach RJT (24, 60, 120 Monate) wurden im Gruppenvergleich evaluiert.

Ergebnisse Pathologische US-Parameter waren signifikant häufiger in der Gruppe 1 nachweisbar im Vergleich zu den Gruppen 2 und 3, jedoch nicht im Vergleich der Gruppen 2 und 3. US-Befunde, welche auf eine moderate Sialadenitis hindeuteten, waren am signifikantesten mit RJT-Dosen <4000MBq und Zeitintervallen von <24 Monaten nach RJT assoziiert. Pathologische US-Befunde, welche auf eine Sialadenitis mit deutlichem oder komplettem Parenchym-Verlust hindeuteten, zeigten die häufigsten und die höchsten signifikanten Assoziationen mit Dosen von >7000–9000MBq und mit einem Zeitintervall von >60 Monaten nach RJT.

Schlussfolgerungen Die im US erhobenen pathologischen Befunde der großen Kopf-Speicheldrüsen nach erfolgter RJT deuten darauf hin, dass die Effekte dosis- und zeitabhängig sein können. Eine Analyse kann helfen, sowohl die aktuelle Ausprägung der RJT-induzierten Sialadenitis als auch deren weitere Prognose besser einzuschätzen.

Keywords

METHODS & TECHNIQUES - ultrasound - salivary gland - thyroid gland - radioactive iodine - treatment


Publication History

Received: 16 January 2023

Accepted after revision: 29 September 2023

Article published online:
03 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Hartmann T. et al. Radioiodine therapy of benign thyroid-disorders. Nuklearmedizin 2017; 56 (05) 171-176 DOI: 10.3413/Nukmed-0875-17-01. (PMID: 29533423)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Alexander C. et al. Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl Med 1998; 39 (09) 1551-1554 (PMID: 9744341)
    PubMedGoogle Scholar
  • 3 Haugen BR. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26 (01) 1-133
    CrossrefPubMedGoogle Scholar
  • 4 Adramerinas M. et al. Sialadenitis as a complication of radioiodine therapy in patients with thyroid cancer: where do we stand?. Hormones (Athens) 2021; 20 (04) 669-678
    CrossrefPubMedGoogle Scholar
  • 5 Riachy R. et al. Early Sialadenitis After Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Prevalence and Predictors. Int J Endocrinol 2020; 2020: 8649794 DOI: 10.1155/2020/8649794. (PMID: 33163074)
    CrossrefPubMedGoogle Scholar
  • 6 An YS. et al. Symptomatic late-onset sialadenitis after radioiodine therapy in thyroid cancer. Ann Nucl Med 2013; 27 (04) 386-391 DOI: 10.1007/s12149-013-0697-5. (PMID: 23389626)
    CrossrefPubMedGoogle Scholar
  • 7 Jo KS. et al. Significance of Salivary Gland Radioiodine Retention on Post-ablation (131)I Scintigraphy as a Predictor of Salivary Gland Dysfunction in Patients with Differentiated Thyroid Carcinoma. Nucl Med Mol Imaging 2014; 48 (03) 203-211
    CrossrefPubMedGoogle Scholar
  • 8 Lee HN. et al. Salivary gland dysfunction after radioactive iodine (I-131) therapy in patients following total thyroidectomy: emphasis on radioactive iodine therapy dose. Clin Imaging 2015; 39 (03) 396-400 DOI: 10.1016/j.clinimag.2014.12.018. (PMID: 25630229)
    CrossrefPubMedGoogle Scholar
  • 9 Van Nostrand D. Sialoadenitis secondary to (1)(3)(1)I therapy for well-differentiated thyroid cancer. Oral Dis 2011; 17 (02) 154-161 DOI: 10.1111/j.1601-0825.2010.01726.x. (PMID: 21029259)
    CrossrefPubMedGoogle Scholar
  • 10 Hyer S.. et al. Salivary gland toxicity after radioiodine therapy for thyroid cancer. Clin Oncol (R Coll Radiol) 2007; 19 (01) 83-86 DOI: 10.1016/j.clon.2006.11.005. (PMID: 17305259)
    CrossrefPubMedGoogle Scholar
  • 11 Solans R. et al. Salivary and lacrimal gland dysfunction (sicca syndrome) after radioiodine therapy. J Nucl Med 2001; 42 (05) 738-743 (PMID: 11337569)
    PubMedGoogle Scholar
  • 12 Helman J. et al. 99mTc-pertechnetate uptake in parotid acinar cells by the Na+/K+/Cl- co-transport system. J Clin Invest 1987; 79 (05) 1310-1313 DOI: 10.1172/JCI112954. (PMID: 3033020)
    CrossrefPubMedGoogle Scholar
  • 13 Jhiang S.M. et al. An immunohistochemical study of Na+/I- symporter in human thyroid tissues and salivary gland tissues. Endocrinology 1998; 139 (10) 4416-4419 DOI: 10.1210/endo.139.10.6329. (PMID: 9751526)
    CrossrefPubMedGoogle Scholar
  • 14 Almeida JP, Vartanian JG, Kowalski L. P, Clinical predictors of quality of life in patients with initial differentiated thyroid cancers. Arch Otolaryngol Head Neck Surg 2009; 135 (04) 342-346 DOI: 10.1001/archoto.2009.16. (PMID: 19380354)
    CrossrefPubMedGoogle Scholar
  • 15 Almeida JP. et al. Late side effects of radioactive iodine on salivary gland function in patients with thyroid cancer. Head Neck 2011; 33 (05) 686-690
    CrossrefPubMedGoogle Scholar
  • 16 Wu JQ. et al. Systematic evaluation of salivary gland damage following I-131 therapy in differentiated thyroid cancer patients by quantitative scintigraphy and clinical follow-up. Nucl Med Commun 2015; 36 (08) 819-826 DOI: 10.1097/MNM.0000000000000325. (PMID: 25932534)
    CrossrefPubMedGoogle Scholar
  • 17 Sanchez Barrueco A. et al. Incidence and risk factors for radioactive iodine-induced sialadenitis. Acta Otolaryngol 2020; 140 (11) 959-962
    CrossrefPubMedGoogle Scholar
  • 18 Brozzi F. et al. Salivary glands ultrasound examination after radioiodine-131 treatment for differentiated thyroid cancer. J Endocrinol Invest 2013; 36 (03) 153-156 DOI: 10.3275/8335. (PMID: 22522602)
    CrossrefPubMedGoogle Scholar
  • 19 Kim DW. Ultrasonographic Features of the Major Salivary Glands after Radioactive Iodine Ablation in Patients with Papillary Thyroid Carcinoma. Ultrasound Med Biol 2015; 41 (10) 2640-2645 DOI: 10.1016/j.ultrasmedbio.2015.06.010. (PMID: 26215493)
    CrossrefPubMedGoogle Scholar
  • 20 Soo Roh S, Wook Kim D, Jin Baek H. Association of Xerostomia and Ultrasonographic Features of the Major Salivary Glands After Radioactive Iodine Ablation for Papillary Thyroid Carcinoma. AJR Am J Roentgenol 2016; 207 (05) 1077-1081 DOI: 10.2214/AJR.15.15776. (PMID: 27504709)
    CrossrefPubMedGoogle Scholar
  • 21 Horvath E. et al. Radioiodine-Induced Salivary Gland Damage Detected by Ultrasonography in Patients Treated for Papillary Thyroid Cancer. Radioactive Iodine Activity and Risk. Thyroid 2020; 30 (11) 1646-1655
    PubMedGoogle Scholar
  • 22 Simoes Lima GA, López RVM, de Freitas RMC. et al. Evaluation of Parotid Salivary Gland Echo Texture by Ultrasound Examinations and Correlation With Whole-Body Scintigraphy After Radioiodine Therapy in Patients With Differentiated Thyroid Carcinoma. J Ultrasound Med 2020; 39 (09) 1811-1818
    CrossrefPubMedGoogle Scholar
  • 23 Grewal RK. et al. Salivary gland side effects commonly develop several weeks after initial radioactive iodine ablation. J Nucl Med 2009; 50 (10) 1605-1610
    CrossrefPubMedGoogle Scholar