A Functional Scoring System Based on Salivary Gland Scintigraphy for Evaluating Salivary Gland Dysfunction Secondary to ¹³¹I therapy in Patients with Differentiated Thyroid Carcinoma

Introduction: Radioiodine therapy with ¹³¹I (¹³¹I therapy) after total or near-total thyroidectomy has been established as an effective treatment for Differentiated Thyroid Carcinoma (DTC), but can induce dry mouth symptoms by salivary gland damage and impair the patients' quality of life.

Aim: To propose a functional scoring system based on Salivary Gland Scintigraphy (SGS) findings that evaluates development of salivary gland dysfunction secondary to ¹³¹I therapy in patients with DTC.

Materials and methods: This retrospective study evaluated the records of 279 DTC patients who underwent SGS after one or more round(s) of ¹³¹I therapy, using 370 MBqof ^99mTc-pertechnetate. The SGS results were assessed using a novel functional scoring system in the Parotid Glands (PGs) and Submandibular Glands (SMGs) according to visual evaluations based on a three-point uptake score, Washout Rate (%WR) score after lemon-juice stimulation, and functional score. The scores were compared among pre treatment, low-dose (<10 GBq), and high-dose (>10 GBq) groups and among pre treatment, symptom-positive, and symptom-negative groups. Risk factors for dry mouth were analyzed by univariate and multivariate logistic regression analyses.

Results: Dry mouth symptoms developed in 15.4% of the DTC patients after ¹³¹I therapy. The three-point uptake, %WR, and functional scores in both the PG and SMG were statistically significant between low-dose and high-dose groups, and between symptom-positive and symptom-negative groups. The PG/SMG functional scores were independent risk factors for dry mouth (odds ratio, 0.03 and 0.0007 respectively).

Conclusion: SGS-based PG and SMG functional scores were effective biomarkers to objectively evaluate salivary gland dysfunction, with the high strength of association with dry mouth symptoms.