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: 5.56). 02/2005; 46(2):261-6.
Source: PubMed

ABSTRACT 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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    ABSTRACT: Background. In this study, the radiosensitizing effect of resveratrol as a natural product was investigated on cell toxicity induced by (131)I in thyroid cancer cell. Methods. Human thyroid cancer cell and human nonmalignant fibroblast cell (HFFF2) were treated with (131)I and/or resveratrol at different concentrations for 48 h. The cell proliferation was measured by determination of the percent of the survival cells using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Results. Findings of this study show that resveratrol enhanced the cell death induced by (131)I on thyroid cancer cell. Also, resveratrol exhibited a protective effect on normal cells against (131)I toxicity. Conclusion. This result indicates a promising effect of resveratrol on improvement of cellular toxicity during iodine therapy.
    Journal of Toxicology 09/2014; 2014:839597. DOI:10.1155/2014/839597
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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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    ABSTRACT: Background. The most appropriate therapy for papillary microcarcinoma (PMC) is controversial. Methods. We reviewed the therapy and outcome of 407 patients with PMC. Results. Three hundred-eighty patients underwent total thyroidectomy, and 349 patients received I-131 therapy. The median followup was 5.3 years. Forty patients developed recurrent disease. On univariate analysis, development of disease recurrence was correlated with histological tumor size > 0.8 cm (P = 0.0104), age < 45 years (P = 0.043), and no I-131 therapy (P < 0.0001). On multivariate analysis, histological tumor size > 0.8 cm, positive lymph nodes, and no I-131 therapy were significant. The 5-year RFS for patients treated with I-131 was 95.0% versus 78.6% (P < 0.0001) for patients not treated with I-131. Patients with lymph node metastasis who did not receive I-131 had a 5-year RFS of 42.9% versus 93.2% (P < 0.0001) for patients who received I-131. Conclusions. Recommend I-131 remnant ablation for patients with PMC, particularly patients with lymph node metastasis.
    03/2012; 2012:816386. DOI:10.5402/2012/816386
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    • "One letter to the editor, one case report, and two subsequent articles have challenged Nakada's report (Lam and van Isselt, 2005; Silberstein, 2008, Van Nostrand et al, 2009, 2010). Lam and van Isselt (2005) in a letter to the editor stated that (1) Ô… [some] patients [with higher salivary gland side effects] … tended to be treated more intensively…', (2) Ô… the reported incidence of salivary gland injury [varied] considerably depending on the diagnostic criteria', and (3) Ô… the author's concept of salivary gland function has not been studied physically'. In a study to evaluate the utility of pilocarpine, Silberstein (2008) administered continuous sialagogues while the patient was awake and intermittently during the night. "
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    ABSTRACT: Radioiodine (¹³¹I) is an important therapy for patients who have well-differentiated thyroid cancer. However, ¹³¹I may also result in side effects in multiple organs and glands. The glands that are frequently affected are the salivary glands with the major untoward effects including sialoadenitis and increased risk of second primary malignancy. This report will review sialoadenitis secondary to ¹³¹I therapy including (1) proposed mechanisms, (2) incidence and clinical presentations, (3) possible approaches to improve prevention, (4) management, and (5) sequelae of sialoadenitis (e.g. xerostomia and salivary duct obstruction). A discussion of second primary malignancies is beyond the scope of this review. With a better understanding of the above, dentists, oral surgeons, otolaryngologists, endocrinologists, nuclear medicine physicians, and nuclear radiologists will be more likely to implement more effective preventive measures to reduce the incidence and severity of ¹³¹I-induced sialoadenitis, and if it does occur, to identify and treat sialoadenitis sooner, thereby potentially reducing not only the severity of the initial symptoms, but also the severity of subsequent sequelae.
    Oral Diseases 10/2010; 17(2):154-61. DOI:10.1111/j.1601-0825.2010.01726.x · 2.40 Impact Factor
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