Late side effects of radioactive iodine on salivary gland function in patients with thyroid cancer.

BACKGROUND: The purpose of this study was to assess the late side effects of radioiodine therapy (RIT) on salivary gland function. One hundred eighty two patients were evaluated. METHODS: Assessment of salivary gland function was performed with salivary gland scintigraphy (SGS), sialometry, and subjective open questions to determine common side effects of RIT on salivary gland function. RESULTS: RIT had a strong association with decreased elimination counts by SGS. Patient age was the only variable associated with sialometry; age and the use of xerostomic drugs were strongly associated with decreased mean values of salivary flow. Dysphagia was strongly associated with RIT. Using multiple logistic regression analysis, age was determined to be an important factor associated with salivary gland dysfunction, and RIT was associated with impairment of saliva excretion. CONCLUSION: These results show that patients subjected to RIT have more difficulty in draining saliva, mainly from the parotid glands, which is associated with clinical dysphagia in this subset of patients.

Pilocarpine used to treat xerostomia in patients submitted to radioactive iodine therapy: a pilot study.

UNLABELLED: Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. AIM: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT). MATERIALS AND METHODS: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. DESIGN: it is a prospective, non-randomized study. RESULTS: Sudoresis was the most frequent side effect of pilocarpine use, followed by fatigue and headache. Two patients reported relief of xerostomia using pilocarpine, but only one patient was able to tolerate the side effects. CONCLUSIONS: Pilocarpine seems to relieve xerostomia complaints in thyroid cancer patients because it is able to stimulate salivary flow, but the observed side effects made the patients refuse long-term therapy continuation.

Pilocarpina no tratamento de xerostomia em pacientes submetidos à iodoterapia: estudo piloto / Pilocarpine used to treat xerostomia in patients submitted to radioactive iodine therapy: a pilot study

Xerostomia é uma queixa tardia frequente associada à iodoterapia. Terapias para o tratamento desta morbidade podem proporcionar melhora na qualidade de vida dos pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. OBJETIVOS: Relatar a experiência com o uso da pilocarpina no tratamento de xerostomia em pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. MATERIAL E MÉTODOS: Cinco pacientes preencheram os critérios de inclusão e receberam 5mg de pilocarpina, 3 vezes ao dia, por uma semana. Os efeitos colaterais do medicamento e a resposta subjetiva à queixa de xerostomia após o tratamento foram avaliados. DESENHO DO ESTUDO: Trata-se de um estudo prospectivo, não-randomizado. RESULTADOS: Sudorese foi o efeito colateral mais comum com o uso da pilocarpina, seguido por cansaço e dor de cabeça. Dois pacientes relataram alívio da xerostomia com o uso da medicação, mas somente um paciente foi capaz de tolerar os efeitos colaterais. CONCLUSÕES: Pilocarpina parece aliviar os sintomas de xerostomia em pacientes submetidos à iodoterapia, já que o medicamento é capaz de estimular o fluxo salivar. No entanto, os efeitos colaterais observados inviabilizam seu uso por recusa por parte dos pacientes em continuar a terapia por períodos mais longos.

Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. AIM: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT). MATERIALS AND METHODS: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. DESIGN: it is a prospective, non-randomized study. RESULTS: Sudoresis was the most frequent side effect of pilocarpine use, followed by fatigue and headache. Two patients reported relief of xerostomia using pilocarpine, but only one patient was able to tolerate the side effects. CONCLUSIONS: Pilocarpine seems to relieve xerostomia complaints in thyroid cancer patients because it is able to stimulate salivary flow, but the observed side effects made the patients refuse long-term therapy continuation.

Clinical predictors of quality of life in patients with initial differentiated thyroid cancers.

BACKGROUND: Patients with differentiated thyroid cancer (DTC) usually have a good prognosis. Traditionally, treatment success in patients with cancer has been evaluated by survival time. Recently, it has been observed that the diagnosis and treatment of cancer also have a strong effect on the quality of life (QOL) of these patients. OBJECTIVE: To assess the QOL of patients with DTC and its potential clinical predictors. DESIGN: Cross-sectional analysis. SETTING: A tertiary cancer institution. PATIENTS: One hundred fifty-four patients submitted to thyroidectomy (1997-2006) were evaluated using the University of Washington Quality of Life questionnaire. MAIN OUTCOME MEASURES: Descriptive analysis of the results was done, as bivariate and multivariate analyses to compare each independent variable with each of 13 QOL domains. RESULTS: Patients 45 years or younger had better recreation scores than did patients older than 45 years (P = .04). Thirty-eight patients were submitted to neck dissection. Patients submitted to modified radical neck dissection reported worse chewing and shoulder scores than did patients submitted to selective paratracheal lymph node dissection only and those without neck dissection (P = .003 and P = .004, respectively). Patients who received more than 150 mCi of radioactive iodine therapy (RIT) reported significantly worse pain, swallowing, chewing, speech, taste, anxiety, and composite scores. Comorbidities showed significant effect on recreation, activity, speech, saliva, and composite scores (P = .02, P = .046, P = .02, P = .01, and P = .008, respectively). In multivariate analysis, RIT is the only variable associated with a worse composite score (P = .003). CONCLUSION: Although QOL after treatment of thyroid cancer can be considered good for most patients, those submitted to RIT at doses higher than 150 mCi are at risk for poor QOL and, therefore, may need more intensive follow-up and treatment.

Avaliação dos efeitos colaterais da iodoterapia adjuvante sobre as glândulas salivares em pacientes com carcinoma bem-diferenciado de tireóide / Evaluation of adjuvant radioactive iodine therapy side effects on salivary glands in patients with well-differentiated thyroid carcinoma

Introdução: A saliva exerce funções fundamentais para a manutenção da função oral. Alterações qualitativas ou quantitativas na saliva interferem diretamente nas funções exercidas pela mesma na manutenção da saúde oral e funções como fala, mastigação e deglutição... Objetivo: Este estudo tem por objetivo avaliar os efeitos colaterais tardios da iodoterapia sobre as glândulas salivares e seu impacto na qualidade de vida dos pacientes submetidos a esta terapia, e investigar a eficácia da amifostina como protetor das glândulas salivares aos efeitos deletérios da iodoterapia. Metodologia: Cintilografia de glândulas salivares, sialometria e aplicação do questionário de Qualidade de Vida da Universidade de Washington e algumas questões elaboradas pelos pesquisadores foram utilizadas para avaliar tanto os efeitos tardios como o efeito protetor da amifostina aos danos associados a iodoterapia. Resultados: Em relação aos efeitos colaterais tardios da iodoterapia verificamos que a idade é um fator importante na função das glândulas salivares, onde pacientes acima de 45 anos apresentam fluxo salivar não-estimulado e estimulado menores, mas que pacientes submetidos a iodoterapia apresentam uma dificuldade de eliminação concentrada principalmente em parótidas verificada tanto por cintilografia das glândulas salivares como por sialometria... Conclusão: O presente estudo reforça teoria de que o principal efeito do 131I sobre as glândulas salivares resulta em uma dificuldade de eliminação da saliva produzida em quantidades normais por uma constrição ductal devido a fibrose periductal induzida pela radiação. Além disso, estas alterações causam impacto na qualidade de vida e queixas acentuadas relacionadas à deglutição... A administração da amifostina, um medicamento com efeito adverso de hipotensão potencial, em pacientes em estado de hipotireoidismo deve ser realizada com cautela, visto que estes pacientes apresentam dificuldade de compensão da pressão diastólica.

Introduction: Saliva plays important functions in maintaining oral functions Qualitative or quantitative saliva alterations can impact on functions as oral health maintainance, speeking, chewing and swallowing functions. The salivary glands are able to concentrate iodine and the 131I passing through salivary ducts, during radioiodine therapy, results as salivar alterations after treatment due to emission of radiotion by iodine. Objective: This study aims to evaluate the late side effects of radioactive iodine therapy (RIT) on salivary glands and its impact on quality of life of these patients, and to investigate the efficacy of amifostine as salivary gland protector to iodine side effects. Methods: Salivary gland scintigraphy, sialometry and the questionnaire of University of Washington Quality of Life and some questions designed by the researches were used to evaluate the late side effects and the protector efficacy of amifostine to salivary gland damage associated to RIT. Reults: About late side effects of RIT, the age was an important factor in the function of salivary glands, with patients older 45 years having a descreased unstimulated and stimulated salivary flow. Patients submitted to RIT have more difficulty to eliminate saliva, mainly from parotids, verified by salivary gland scintigraphy and sialometry. In relation to quality of life, doses of iodine higher than 150 mCi have impact in salivary functions as speech, chewing and swallowing. Evaluating the protective effect of amifostine on late effects of RIT on salivary glands, it was not verified the efficacy of this drug, with serious side effects associated to endovenous via of administration. Conclusion: The present study reinforce the theory that the main effect of 131I on salivary glands results in difficulty to eliminate the saliva produced, in normal quantities, by a ductal constriction due to periductal fibrosis induced by radiation. Besides that, these alterations have impact on quality of life and severe complaints related to swallowing. The amifostine was not able to prevent side effects of RIT on salivary glands in the present study. The amifostine administration, a drug with known hipotensive effect, in patients withdraw thyroid hormone must be done carefully, since these patients have difficulty to compensate the diastolic blood pressure.