Radioiodine sialadenitis

Radioiodine (¹³¹I) is a radiobiologic medication administered to patients with benign and malignant thyroid disease for the destruction of thyroid follicular cells. Given the increased detection and treatment of well-differentiated thyroid cancer, the use of radioiodine has increased over the last several decades. While the medication’s toxicity profile has traditionally been considered favorable, recent studies are now demonstrating that 10-60% of patients may develop symptoms of sialadenitis. Multiple interventions for the prevention of radioiodine sialadenitis have been proposed, although consensus support has yet to be achieved. Patients developing the disorder are first offered medical therapy consisting of hydration, gland massage, warm compresses, anti-inflammatories, cholinergic medications, and antibiotics, as indicated. Patients who fail medical management are now offered interventional sialendoscopy, a newer technology employing the use of small endoscopes and ancillary instruments to manage the thick mucus plugs, ductal debris, and ductal stenosis associated with the disorder. To date, across all studies, a consistent majority of patients undergoing treatment have reported improvement in symptoms. Patients who fail endoscopic intervention may undergo repeat sialendoscopy or sialadenectomy. Additional higher-powered studies are needed to assess the quality and degree of symptom improvement in these patients.