Long-Term Effects of Radioiodine Treatment on Salivary Gland Function in Adult Survivors of Pediatric Differentiated Thyroid Carcinoma

Tharsana Selvakumar, Marloes Nies, Marielle S. Klein Hesselink, Adrienne H. Brouwers, Anouk N. A. van der Horst-Schrivers, Esther N. Klein Hesselink, Wim J. E. Tissing, Arjan Vissink, Thera P. Links*, Gianni Bocca, Johannes G. M. Burgerhof, Eveline W. C. M. van Dam, Bas Havekes, Marry M. van den Heuvel-Eibrink, Eleonora P. M. Corssmit, Leontine C. M. Kremer, Romana T. Netea-Maier, Heleen J. H. van der Pal, Robin P. Peeters, Johannes W. A. SmitJohn T. M. Plukker, Cecile M. Ronckers, Hanneke M. van Santen, Dutch Pediatric Thyroid Cancer Study Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Pediatric differentiated thyroid cancer (DTC) is a rare disease. Initial treatment of DTC consists of a total or near-total thyroidectomy and I-131 therapy. Previous studies on adults showed that I-131 treatment may reduce salivary gland function (SGF). Studies regarding SGF in children treated for DTC are sparse. Our aim was to assess the long-term effects of I-131 treatment on SGF in survivors of pediatric DTC. Methods: In a nationwide cross-sectional study, SGF in patients treated for pediatric DTC between 1970 and 2013 (>5 y after diagnosis, >= 18 y old at the time of evaluation) was studied. SGF was assessed by sialometry, sialochemistry, and a xerostomia inventory. Salivary gland dysfunction (SGD) was defined as an unstimulated whole saliva flow of no more than 0.2 mL/min or a stimulated whole saliva flow of no more than 0.7 mL/min. Results: Sixty-five patients underwent I-131 treatment (median age at evaluation, 33 y, with an interquartile range [IQR] of 25-40 y; 86.2% female; median follow-up period, 11 y, with an IQR of 6-22 y). Median cumulative I-131 activity was 5.88 GBq, with an IQR of 2.92-12.95 GBq, and 47.7% underwent multiple I-131 administrations. SGD was present in 30 (47.6%) patients. Levels of amylase and total protein in saliva were reduced. Moderate to severe xerostomia was present in 22 (35.5%) patients. Stimulated salivary secretion was lower and the severity of xerostomia complaints higher in patients treated with higher cumulative I-131 activity. Conclusion: In survivors of pediatric DTC, clinically significant SGD was found in 35.5% and was related to the cumulative I-131 activity of the treatment.

Original languageEnglish
Pages (from-to)172-177
Number of pages6
JournalJournal of Nuclear Medicine
Issue number2
Publication statusPublished - 1 Feb 2019


  • pediatric differentiated thyroid carcinoma
  • radioiodine treatment
  • salivary gland dysfunction
  • xerostomia
  • I-131 THERAPY
  • RISK
  • FLOW

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