Does Lemon Candy Decrease Salivary Gland Damage After Radioiodine Therapy for Thyroid Cancer?

Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8636, Japan.
Journal of Nuclear Medicine (Impact Factor: 6.16). 02/2005; 46(2):261-6.
Source: PubMed


Salivary gland dysfunction is one of the common side effects of high-dose radioiodine therapy for thyroid cancer. The purpose of this study was to determine whether an early start of sucking lemon candy decreases salivary gland injury after radioiodine therapy.
The incidence of the side effects of radioiodine therapy on the salivary glands was prospectively and longitudinally investigated in 2 groups of patients with postsurgical differentiated thyroid cancer with varying regimens for sucking lemon candy. From August 1999 to October 2000, 116 consecutive patients were asked to suck 1 or 2 lemon candies every 2-3 h in the daytime of the first 5 d after radioiodine therapy (group A). Lemon candy sucking was started within 1 h after radioiodine ingestion. From November 2000 to June 2002, 139 consecutive patients (group B) were asked to suck lemon candies in a manner similar to that of group A. In the group B, lemon candies were withheld until 24 h after the ingestion of radioiodine. Patients with salivary gland disorders, diabetes, collagen tissue diseases, or a previous history of radioiodine therapy or external irradiation to the neck were excluded. Thus, 105 patients in group A and 125 patients in group B were available for analysis. There were no statistical differences in the mean age (55.2 y vs. 58.5 y), average levels of serum free thyroxine (l-3,5,3',5'-tetraiodothyronine) (0.40 ng/dL vs. 0.47 ng/dL), and the mean dose of (131)I administered (3.96 GBq vs. 3.87 GBq) between the 2 groups. The onset of salivary side effects was monitored during hospital admission and regular follow-up on the basis of interviews with patients, a visual analog scale, and salivary gland scintigraphy using (99m)Tc-pertechnetate. When a patient showed a persistent (>4 mo) dry mouth associated with a nonfunctioning pattern on salivary gland scintigraphy, a diagnosis of xerostomia was established.
The incidences of sialoadenitis, hypogeusia or taste loss, and dry mouth with or without repeated sialadenitis in group A versus group B were 63.8% versus 36.8% (P < 0.001), 39.0% versus 25.6% (P < 0.01), and 23.8% versus 11.2% (P < 0.005), respectively. Permanent xerostomia occurred in 15 patients in group A (14.3%) and 7 patients in group B (5.6%) (P < 0.05). In both groups, bilateral involvement of the parotid gland was the most frequently seen and was followed by bilateral involvement of the submandibular gland.
An early start of sucking lemon candy may induce a significant increase in salivary gland damage. Lemon candy should not be given until 24 h after radioiodine therapy.

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Available from: Kunihiro Nakada, Jan 22, 2014
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    • "Reactive oxygen species (ROS) are generated by 131 I [2] [3]; these toxic products can attack critical macromolecules, such as DNA, leading to cell damage and death [4] [5]. However, 131 I concentrates at high level in thyroid tissue with a high target to nontarget ratio which is perfect for thyroid cancer therapy; it has side effects, such as sialadenitis, haematological depression, xerostomia, and radiation thyroiditis [6] [7] [8] [9] [10] [11]. "
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    • "Short- and long-term side effects related to radioiodine therapy are nausea, sialadenitis, and hematological depression. Since iodine is secreted in salivary glands at high concentration, salivary gland dysfunction is reported in patients undergoing 131I therapy.[4] In addition to these side effects, there is an induction of secondary primary cancer and genetic damage following in 131I therapy. "
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    • "After treatment with I-131, patients rarely experience headache, fatigue, nausea, and vomiting acutely [28]. More commonly, patients develop acute sialoadenitis [29]. Typically, acute toxicity resolves rapidly. "
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