1. Patterns of Salivary Pain Occurring 7 days to 3months after 131I —A National Survey of ThyCa: Thyroid Cancer Survivors’ Assoc., Inc.
Khorjekar G1, Hall J1, Van Nostrand D1, Kharazi P1, Schneider M1, Brennan M2, McIver G3, Mete M4, Bloom G5
Washington Hospital Center, Division of Nuclear Medicine1, Carolinas Medical Center2, Mayo Clinic3,
MedStar Health Research Institute4, ThyCa: Thyroid Cancer Survivors’ Association, Inc.5
Abstract Introduction Results (cont’d) Discussion
Objectives: The objective was to evaluate the patterns Patient’s diagnosed with thyroid cancer undergo (ii) accentuation of salivary pain with eat 2) (Flow Chart 3), and (iii) Limitations for our study could be reliability of
of SALIVARY PAIN that began between 7 days to 3 thyroidectomy followed by radioiodine therapy with 131I. The interventions were antibiotics, pilocarpine, steroids, hydrocodone, patient response, for example may be the patient
months after the 131I therapy for differentiated thyroid common side effects post 131I therapy are: nausea, vomiting, sialogram, and/or surgical removal of salivary gland in 1,1,3,1,2, and did not remember the correct responses for the
cancer. and salivary gland side effects such as pain, tenderness, questions asked in the survey. Other limitation
Methods: A survey was e-mailed to the associates of
2, respectively (Flow Chart 4). In Group 2, the number of patients
swelling, dryness of mouth and altered taste sensation (2). To reporting (i) duration of each episode of intermittent salivary pain could be, the patient took the survey more than
ThyCa and was available to anyone on its website. Only
responses of patients with differentiated thyroid cancer evaluate the patterns of SALIVARY PAIN that began between lasting same times as above was 1,6,10,13,8,5, and 2, respectively, once. Also, patients who took the survey were all
for their last 131I therapy in the United States were 7 days to 3 months after the 131I therapy for differentiated (ii) the durations that the patient had episodes of intermittent salivary internet users and those who did not have internet
tabulated for the above time period. The survey question thyroid cancer, a survey was designed and was sent to the pain with same times were 0,1,4,11,30, and 6, respectively (Flow access could not participate in the survey. One of
was open text to report duration of salivary pain with any patients who are diagnosed with thyroid cancer and received Chart 2); (iii) triggers of salivary pain after eating occurred in the limitations could be categorization of the
additional characterization of salivary pain. 131I therapy.
29(19%) patients and increased blood pressure in 1(6%) patients patient’s responses for pain in the comment
Results: Out of ~15,000 surveys, 2024 patients section. This was tough, as two of the attendings
responded who met the above criteria. 1371 had no Methods (Flow Chart 3); , and (iii) no intervention was reported (Flow Chart 4).
graded the patients responses as either
salivary pain and 653 (48%) had salivary pain. Of the A survey was e-mailed to the associates of ThyCa and Table 1 Table 1 continuous pain and intermittent pain. However, if
latter, 224 patients described their pattern of salivary was available to anyone on its website. Only responses of the responses were not clear whether they should
pain, and 2 distinct patterns were identified--continuous patients with differentiated thyroid cancer for their last 131I
(69[31%])(Groups 1) and intermittent (155 be categorized in the continuous pain or in the
therapy in the United States were tabulated for the above intermittent pain category, those responses were
[69%])(Group2). Of the small number of patients who
further characterized their salivary pain for duration,
time period. The survey question was open text to report graded as indeterminate and were not included in
triggers that caused/accentuated the salivary pain, duration of salivary pain with any additional characterization the study data. Table 2 demonstrates some of the
and/or interventions, the number of patients in Group 1 of salivary pain. actual responses of the patients from the survey.
reporting (i) durations of continuous salivary pain lasting
Flow Chart 1 Considering all the above limitations, further study
minutes, hours, days, weeks, months or years were
Results
is warranted to better evaluate continuous and
0,0,3,3,16, and 3, respectively; (ii) accentuation of Out of ~15,000 surveys sent out, 2024 patients
intermittent pain. By being aware of these two
salivary pain with eating occurred in one patient (1%), responded and met the above criteria. Demographics is
patterns of salivary pain and potential etiologies,
and (iii) interventions were antibiotics, pilocarpine, shown in Table 1. There was no statistical relationship
steroids, hydrocodone, sialogram, and/or surgical
the physician may be able to implement more
observed for age, gender, prescribed activity of 131I, and/or timely and appropriate management. Hence
removal of salivary gland in 1,1,3,1,2, and 2, prior 131I therapies to pattern of salivary pain, duration,
respectively. In Group 2, the number of patients further study is warranted to better evaluate
factors accentuating salivary pain, and interventions. Out of continuous and intermittent pain.
reporting (i) duration of each episode of intermittent
2024, 1371 patients had no salivary pain and 653 (48%) had
salivary pain lasting the same time as above was
salivary pain. Of the latter, 224 patients described their Conclusion
1,6,10,13,8,5, and 2, respectively; (ii) the durations that Incidence of salivary pain beginning 7 days to 3
the patient had episodes of intermittent salivary pain with pattern of salivary pain, and 2 distinct patterns were
months after 131I therapy of DTC is high (48%).
the same times were 0,1,4,11,30, and 6, respectively; identified--continuous (69[31%])(Groups 1) and intermittent Flow Chart 2 Flow Chart 3 Flow Chart 4 Of those with salivary pain, intermittent pain was
(iii) triggers of salivary pain after eating occurred in (155 [69%])(Group2) as shown in flow chart 1. Of the small
29(19%) patients and increased blood pressure in 1(6%) twice as frequent as continuous pain (69% vs
number of patients who further characterized their salivary
patients, and (iii) no intervention was reported. 31%). Intermittent pain was accentuated by
pain for duration, triggers that caused/accentuated the
Summary: During the period of 7 days to 3 months after salivation more frequently than continuous pain
131I therapy of differentiated thyroid cancer, two patterns salivary pain, and/or interventions, the number of patients in
(26% vs 1.4%).
of salivary pain were identified suggesting two different Group 1 reporting (i) durations of continuous salivary pain References
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