radioiodine removal effect of massage on parotid glands
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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.
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