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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 Hospital Department of Nuclear Medicine. Introduction.
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Radioiodine Removal Effect of Massage on Parotid Glands Chae Moon Hong, Byeong-CheolAhn, Seung Hyun Son, Choon Young Kim, Do-Hoon Kim, Shin Young Jeong, Sang-Woo Lee, Jaetae Lee Kyungpook National University Hospital Department of Nuclear Medicine
Introduction Radioiodine and Xerostomia • Radioiodine therapy is widely used in thyroid cancer patients • Research that focuses on how to minimize the impact of radioiodine on the salivary glands in order to prevent sialadenitis and xerostomiawould provide a significant benefit to patients. ATA guideline, 2009
Introduction 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 pertechnetate from the PG and reduce radioisotope accumulation in the glands Kim et al. Thyroid, 2012
Introduction Salivary gland massage Limitation Tc-99m pertechnetate Thyroid Hormone Withdrawal (THW) Kim et al. Thyroid, 2012
Introduction Purpose • To evaluate the effect of parotid gland (PG) massage for removal of radioiodine from the PG using I-123.
Materials and methods 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 ablation
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 institutional review board of Kyungpook National 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 • 2 Hours after I-123 administration Group A (23 patients) 1 Min Rest 1 min Massage 1st Scan 2nd Scan 3rd Scan Group B (21 patients) 2 Mins Rest 1st Scan 2nd Scan 3rd Scan 2 mins Massage
Materials and methods Total counts of parotid glands 3rd Scan 2nd Scan 1st Scan
Results Accumulation Ratios of parotid glands P = 0.001 P < 0.001 (%) (%) 20 20 15 15 10 10 5 5 0 0 -5 -5 -10 -10 -15 -15 Control Massages Control Massages Group A Group B
Conclusion • PG massage can remove radioiodine from the PG and reduce radiation exposure to the PG. • Effect of 1 minute PG massage has comparable effect to 2 minutes PG massage. • PG massage can be applied to thyroidectomized thyroid cancer patients who received high-dose radioiodine therapy for prevention of or reduction of PG dysfunction.
