Radioiodine Removal Effect of Massage on Parotid Glands

Chae Moon Hong, Byeong-Cheol Ahn, Seung Hyun Son, Choon Young Kim, Do-Hoon Kim, Shin Young Jeong, Sang-Woo Lee, Jaetae Lee

Kyungpook National University HospitalDepartment of Nuclear Medicine

Radioiodine and Xerostomia

•Radioiodine therapy is widely used in thy-roid cancer patients

•Research that focuses on how to minimize the impact of radioiodine on the salivary glands in order to prevent sialadenitis and xerostomia would provide a significant benefit to patients.

Introduction

ATA guideline, 2009

Salivary gland protection

•Efforts to reduce radiation exposure of the salivary glands include hydration, salivary stimulation with sialagogues, and salivary gland massage.

•Kim et al. reported that parotid gland (PG) massage can expel Tc-99m pertech-netate from the PG and reduce radioiso-tope accumulation in the glands

Introduction

Kim et al. Thyroid, 2012

Salivary gland massage

Kim et al. Thyroid, 2012

Limitation Tc-99m pertechnetate Thyroid Hormone Withdrawal (THW)

Introduction

Purpose

•To evaluate the effect of parotid gland (PG) massage for removal of radioiodine from the PG using I-123.

Introduction

Patients characteristics

•From February 2012 to July 2012•PG massages and salivary gland scans

were performed who underwent I-123 whole body scan.

•Inclusion criteria▫Total thyroidectomy due to thyroid cancer▫Followed by 3.7-5.6 GBq of radioiodine ab-

lation

Materials and methods

Patients characteristics• Exclusion criteria

▫ Distant metastases

▫ Additional radioiodine therapy

▫ External radiation history of the head and neck area

▫ Any symptoms of salivary gland dysfunction

▫ Failed to achieve optimal thyroid hormone withdrawal status TSH>30uIU/mL and free T4<0.3ng/dL

▫ Non-visible PG on 2 hour salivary gland scans after administration of I-123

Materials and methods

Patients characteristics

•44 patients (39 women and 5 men)•Mean age : 49.1 ± 11.1 years.

•The study design was approved by the in-stitutional review board of Kyungpook Na-tional University Hospital and informed consent was obtained.

Materials and methods

Preparation for scan

•Low iodine diet for 2 weeks

•Discontinued T4 and switched to T3▫4 weeks prior to the I-123 administration

•Withdrawal of T3 for 2 weeks

•18.5 MBq of I-123 was given orally

Materials and methods

PG massages and salivary gland scans

Materials and methods

1 min Massage

1st Scan 2nd Scan 3rd Scan

2 mins Massage1st Scan 2nd Scan 3rd Scan2 Mins Rest

1 Min Rest

•2 Hours after I-123 administration

Group A

Group B

(23 patients)

(21 patients)

Total counts of parotid glands

1st Scan 2nd Scan 3rd Scan

Materials and methods

Accumulation Ratios of parotid glands

Results

Group A Group B

Group A Group B p-values

ARcon 5.73±3.44 % 6.19±3.77 % 0.670

ARmas 0.54±6.80 % -1.14±5.72 % 0.384

p-values 0.001 <0.001

-5

0

5

Control Massages

-15

-10

-5

0

5

10

15

20

Control Massages

P < 0.001P = 0.001(%)

-15

-10

10

15

20(%)

Conclusion•PG massage can remove radioiodine from the

PG and reduce radiation exposure to the PG.

•Effect of 1 minute PG massage has compara-ble effect to 2 minutes PG massage.

•PG massage can be applied to thyroidec-tomized thyroid cancer patients who received high-dose radioiodine therapy for prevention of or reduction of PG dysfunction.

Thank you for your attention