Two patterns of salivary pain were identified in thyroid cancer patients following 131I therapy between 7 days to 3 months: continuous pain and intermittent pain. Continuous pain lasted minutes to years for some patients and was accentuated by eating in 1% of patients. Intermittent pain occurred in episodes for some patients and was accentuated by eating in 19% of patients. The study had limitations but provides insight into characterizing salivary pain patterns to help manage side effects of 131I therapy. Further research is warranted.

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 patient response, for example may be the patient
months after the 131I therapy for differentiated thyroid common side effects post 131I therapy are: antibiotics, pilocarpine, steroids, hydrocodone, sialogram, and/or did not remember the correct responses for the
cancer. nausea, vomiting, and salivary gland side effects such as questions asked in the survey. Other limitation
Methods: A survey was e-mailed to the associates of
surgical removal of salivary gland in 1,1,3,1,2, and 2, respectively
pain, tenderness, swelling, dryness of mouth and altered (Flow Chart 4). In Group 2, the number of patients reporting (i) 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 taste sensation (2). To evaluate the patterns of SALIVARY duration of each episode of intermittent salivary pain lasting same once. Also, patients who took the survey were all
for their last 131I therapy in the United States were PAIN that began between 7 days to 3 months after the 131I times as above was 1,6,10,13,8,5, and 2, respectively, (ii) the internet users and those who did not have internet
tabulated for the above time period. The survey question therapy for differentiated thyroid cancer, a survey was durations that the patient had episodes of intermittent salivary pain access could not participate in the survey. One of
was open text to report duration of salivary pain with any designed and was sent to the patients who are diagnosed with same times were 0,1,4,11,30, and 6, respectively (Flow Chart the limitations could be categorization of the
additional characterization of salivary pain. with thyroid cancer and received 131I therapy. 2); (iii) triggers of salivary pain after eating occurred in 29(19%) 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 patients and increased blood pressure in 1(6%) patients (Flow Chart
graded the patients responses as either
A survey was e-mailed to the associates of ThyCa and 3); , and (iii) no intervention was reported (Flow Chart 4).
Table 1
salivary pain and 653 (48%) had salivary pain. Of the 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
time period. The survey question was open text to report graded as indeterminate and were not included in
duration, triggers that caused/accentuated the salivary duration of salivary pain with any additional characterization the study data. Table 2 demonstrates some of the
pain, and/or interventions, the number of patients in of salivary pain. actual responses of the patients from the survey.
Group 1 reporting (i) durations of continuous salivary
Flow Chart 1 Considering all the above limitations, further study
pain lasting minutes, hours, days, weeks, months or
Results
is warranted to better evaluate continuous and
years were 0,0,3,3,16, and 3, respectively; (ii) Out of ~15,000 surveys sent out, 2024 patients
intermittent pain. By being aware of these two
accentuation of salivary pain with eating occurred in one responded and met the above criteria. Demographics is
patterns of salivary pain and potential
patient (1%), and (iii) interventions were shown in Table 1. There was no statistical relationship
antibiotics, pilocarpine, steroids, hydrocodone, sialogram
etiologies, the physician may be able to implement
observed for age, gender, prescribed activity of 131I, and/or more timely and appropriate management. Hence
, and/or surgical removal of salivary gland in prior 131I therapies to pattern of salivary pain, duration,
1,1,3,1,2, and 2, respectively. In Group 2, the number of further study is warranted to better evaluate
factors accentuating salivary pain, and interventions. Out of continuous and intermittent pain.
patients reporting (i) duration of each episode of
2024, 1371 patients had no salivary pain and 653 (48%) had
intermittent salivary pain lasting the same time as above
salivary pain. Of the latter, 224 patients described their Conclusion
was 1,6,10,13,8,5, and 2, respectively; (ii) the durations Incidence of salivary pain beginning 7 days to 3
that the patient had episodes of intermittent salivary pain pattern of salivary pain, and 2 distinct patterns were
months after 131I therapy of DTC is high (48%).
with the same times were 0,1,4,11,30, and 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
6, respectively; (iii) triggers of salivary pain after eating (155 [69%])(Group2) as shown in flow chart 1. Of the small
occurred in 29(19%) patients and increased blood twice as frequent as continuous pain (69% vs
number of patients who further characterized their salivary
pressure in 1(6%) patients, and (iii) no intervention was 31%). Intermittent pain was accentuated by
pain for duration, triggers that caused/accentuated the
reported. salivation more frequently than continuous pain
Summary: During the period of 7 days to 3 months after salivary pain, and/or interventions, the number of patients in
(26% vs 1.4%).
131I therapy of differentiated thyroid cancer, two patterns Group 1 reporting (i) durations of continuous salivary pain References
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