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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