Transcript Radioiodine removal effect of parotid gland massage

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
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 xerostomia
would 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)
1st Scan
Group B
1st
Scan
1 Min Rest
2nd Scan
1 min
Massage
3rd Scan
(21 patients)
2 Mins Rest
2nd Scan
2 mins Massage
3rd Scan
Materials and methods
Total counts of parotid glands
1st Scan
2nd Scan
3rd 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
Group A
Massages
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
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.
Thank you for your attention