Radioactive Iodine Risks in Thyroid Cancer Patients

Reduction in Swallowing-related Quality of Life

thyroid nodule illustration

Thyroid cancer patients may often present with fears or concerns regarding how their cancer treatments may affect their throat and their ability to swallow. According to researchers, radioactive iodine (RAI) therapy may place thyroid cancer patients at increased risk for sialadenitis and decreased head and neck quality of life—a concern that physicians may need to discuss with their patients.

A study was conducted to evaluate the prevalence of salivary gland inflammation in thyroid cancer patients who were treated with RAI, and determine whether RAI treatment had any effect on swallowing-related quality of life.

The results of the study were published online in March 2013 in Otolaryngology—Head and Neck Surgery. The article is titled, “Salivary morbidity and quality of life following radioactive iodine for well-differentiated thyroid cancer.”

The study design included questionnaire-based analysis of a patient cohort selected through the National Cancer Institute’s cancer center registry. The study featured 24 men and 121 women (average age 52). Study participants, all of whom were diagnosed with well-differentiated thyroid cancer, were mailed several questionnaires for completion.

Participants were asked to complete the following:

  • baseline questionnaire
  • MD Anderson Dysphagia Inventory (MDADI)
  • University of Washington Quality of Life Questionnaire (UWQoL)
  • Xerostomia-related Quality of Life Scale (XeQoLS)

The results showed that thyroid cancer patients who had a larger amount of RAI exposure (>150 mCi) were 2.47 times more likely to develop sialadenitis when compared with those patients who were exposed to <150 mCi (P=0.04). High RAI exposure (>150 mCi) was also associated with reductions in certain domains of the various questionnaires:

  • UWQoL – reduction in recreation domain (P=0.04)
  • MDADI – reduction in daily swallowing domain (P=0.02)
  • XeQoLS – reduction in psychological/personal domain (P=0.03)
  • XeQoLS – reduction in pain domain (P=0.03)
  • XeQoLS – reduction in social domain (P=0.04)

Investigators concluded that thyroid cancer patients treated with RAI were at an increased risk for reduction in swallowing-related function and global head and neck quality of life, as well as a higher likelihood of developing salivary gland inflammation.

As a result, it is advisable that thyroid cancer patients undergoing RAI treatment be screened for salivary morbidity during the course of their therapy. Additionally, it may be beneficial to explore with your patients different interventions that can be implemented before and after RAI treatment to help improve their quality of life and assuage any swallowing-related side effects that may arise.

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