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01-12-2021 | Inflammation of the Salivary Gland | Review Article

Sialadenitis as a complication of radioiodine therapy in patients with thyroid cancer: where do we stand?

Authors: Marios Adramerinas, Dimitrios Andreadis, Konstantinos Vahtsevanos, Athanasios Poulopoulos, Kalliopi Pazaitou-Panayiotou

Published in: Hormones | Issue 4/2021

Abstract

Purpose

This study aims to elaborate on the current knowledge concerning the mechanism, frequency, clinical manifestations, diagnostic procedures, prevention, and management of radioactive iodine (RAI)-induced sialadenitis in patients receiving treatment for differentiated thyroid cancer (DTC).

Methods

A review of the literature was carried out through the “www.ncbi.nlm.nih.gov/pubmed” database focusing on the results of the past decade.

Results

The high concentration of RAI in the salivary glands results in high beta radiation exposure of the striated duct cells and stem cells. This exposure leads to acute and/or chronic sialadenitis with obstructive symptoms and progressive loss of salivary gland function and xerostomia, with severe impact on patients’ quality of life. No standard diagnostic method has been established. As far as prevention is concerned, many approaches have been proposed, such as sialogogues, local massage, vitamin E, and amifostine administration. Although there is no unanimity as to their effectiveness, the use of sialogogues is recommended. Treatment includes conservative drug therapy and sialendoscopy when necessary.

Conclusion

RAI-induced sialadenitis has a major impact on patients’ quality of life. Due to the good prognosis of DTC, the reduction of sialadenitis and its prognosis, prevention, and treatment constitute a priority for the overall treatment of these patients. Further studies that will establish a coherent treatment protocol for this condition are necessary.

Haugen BR, Alexander E, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 1:1–133. https://doi.org/10.1089/thy.2015.0020CrossRef

Hesselink EN, Links TP (2015) Radioiodine treatment and thyroid hormone suppression therapy for differentiated thyroid carcinoma: adverse effects support the trend toward less aggressive treatment for low-risk patients. Eur Thyroid J 4:82–92. https://doi.org/10.1159/000432397CrossRef

Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, Tennvall J, Bombardieri E, European Association of Nuclear Medicine (EANM) (2008) Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 35:1941–1959. https://doi.org/10.1007/s00259-008-0883-1CrossRefPubMed

Aktaş A, Kavak K, Kocabaş B, Aras M, Tütüncü NB, Gençoğlu A (2008) The biodistribution of radioiodine on posttherapy iodine131 scans in thyroid cancer patients with chronic renal failure. Nucl Med Commun 29:943–948. https://doi.org/10.1097/MNM.0b013e32831089e0CrossRefPubMed

Spitzweg C, Joba W, Schriever K, Goellner JR, Morris JC, Heufelder AE (1999) Analysis of human sodium iodide symporter immunoreactivity in human exocrine glands. J Clin Endocrinol Metab 84:4178–4184. https://doi.org/10.1210/jcem.84.11.6117CrossRefPubMed

da Fonseca FL, Yamanaka PK, Mazoti L, Arakawa-Sugueno L, Kato JM, Matayoshi S (2017) Correlation among ocular surface disease, xerostomia, and nasal symptoms in patients with differentiated thyroid carcinoma subjected to radioiodine therapy: a prospective comparative study. Head Neck 39:2381–2396. https://doi.org/10.1002/hed.24895CrossRefPubMed

Silberstein EB (2008) Reducing the incidence of 131I-induced sialadenitis: the role of pilocarpine. Randomized Controlled Trial J Nucl Med 49(4):546–549. https://doi.org/10.2967/jnumed.107.049411CrossRefPubMed

La Perle KM, Kim DC, Hall NC, Bobbey A, Shen DH, Paul NRS, Wakely E Jr, Lehman A, Jarjoura D, Jhiang SM (2013) Modulation of sodium/iodide symporter expression in the salivary gland. Thyroid 23:1029–1036. https://doi.org/10.1089/thy.2012.0571CrossRefPubMedPubMedCentral

Holmberg KV, Hoffman MP (2014) Anatomy, biogenesis and regeneration of salivary glands. Monogr Oral Sci 24:1–13. https://doi.org/10.1159/000358776CrossRefPubMedPubMedCentral

10.

Van Nostrand D (2011) Sialoadenitis secondary to ¹³¹I therapy for well-differentiated thyroid cancer. Oral Dis 17:154–161. https://doi.org/10.1111/j.1601-0825.2010.01726.xCrossRefPubMed

11.

Hong CM, Son SH, Kim CY, Kim DH, Jeong SY, Lee SW, Lee J, Ahn BC (2014) Emptying effect of massage on parotid gland radioiodine content. Nucl Med Commun 35:1127–1131. https://doi.org/10.1097/MNM.0000000000000176CrossRefPubMed

12.

Kim YM, Choi JS, Hong SB, Hyun IY, Lim JY (2016) Salivary gland function after sialendoscopy for treatment of chronic radioiodine-induced sialadenitis. Head Neck 38:51–58. https://doi.org/10.1002/hed.23844CrossRefPubMed

13.

Liu B, Kuang A, Huang R, Zhao Z, Zeng Y, Wang J, Tian R (2010) Influence of vitamin C on salivary absorbed dose of 131I in thyroid cancer patients: a prospective, randomized, single-blind, controlled trial. J Nucl Med 51(4):618–623. https://doi.org/10.2967/jnumed.109.071449CrossRefPubMed

14.

Riachy R, Ghazal N, Haidar MB, Elamine A, Nasrallah MP (2020) Early sialadenitis after radioactive iodine therapy for differentiated thyroid cancer: prevalence and predictors. Int J Endocrinol 2020:8649794. https://doi.org/10.1155/2020/8649794CrossRefPubMedPubMedCentral

15.

Hollingsworth B, Senter L, Zhang X et al (2016) Risk factors of ¹³¹I-induced salivary gland damage in thyroid cancer patients. J Clin Endocrinol Metab 101(11):4085–4093. https://doi.org/10.1210/jc.2016-1605CrossRefPubMedPubMedCentral

16.

Alotaibi H, Tuzlakoğlu-Öztürk M, Tazebay UH (2017) The thyroid Na+/I- symporter: molecular characterization and genomic regulation. Mol Imaging Radionucl Ther 26:92–101. https://doi.org/10.4274/2017.26.suppl.11CrossRefPubMedPubMedCentral

17.

Koca G, Gültekin SS, Han U, Kuru S, Demirel K, Korkmaz M (2013) The efficacy of montelukast as a protective agent against 131I-induced salivary gland damage in rats: scintigraphic and histopathological findings. Nucl Med Commun 34:507–517. https://doi.org/10.1097/MNM.0b013e32835ffecdCrossRefPubMed

18.

Kim JW, Kim JM, Choi ME, Kim SK, Kim YM, Choi JS (2020) Does salivary function decrease in proportion to radioiodine dose? Laryngoscope 130(9):2173–2178. https://doi.org/10.1002/lary.28342CrossRefPubMed

19.

Tateishi Y, Sasabe E, Ueta E, Yamamoto T (2008) Ionizing irradiation induces apoptotic damage of salivary gland acinar cells via NADPH oxidase 1-dependent superoxide generation. Biochem Biophys Res Commun 366:301–307. https://doi.org/10.1016/j.bbrc.2007.11.039CrossRefPubMed

20.

Avila JL, Grundmann O, Burd R, Limesand KH (2009) Radiation-induced salivary gland dysfunction results from p53-dependent apoptosis. Int J Radiat Oncol Biol Phys 73:523–529. https://doi.org/10.1016/j.ijrobp.2008.09.036CrossRefPubMedPubMedCentral

21.

Sadiç M, Korkmaz M, Gültekin SS, Demircan K (2016) Alterations in ADAMTS12 gene expression in salivary glands of radioiodine-131-administeredrats. Nucl Med Commun 37:1010–1015. https://doi.org/10.1097/MNM.0000000000000556CrossRefPubMed

22.

Choi JS, Park IS, Kim SK, Lim JY, Kim YM (2013) Morphometric and functional changes of salivary gland dysfunction after radioactive iodine ablation in a murine model. Thyroid 23:1445–1451. https://doi.org/10.1089/thy.2012.0243CrossRefPubMedPubMedCentral

23.

Sadic M, Demirel K, Halacli SO, Karakok E, Koca G, Ekinci O, Demircan K, Korkmaz M (2018) Expression of ADAMTS2 and ADAMTS5 in the salivary gland of rats after radioiodine therapy. Nucl Med Commun 39:110–117. https://doi.org/10.1089/thy.2012.0243CrossRefPubMed

24.

Hesselink ENK, Brouwers AH, de Jong JR, van der Horst-Schrivers AN, Coppes RP, Lefrandt JD, Jager PL, Vissink A, Links TP (2016) Effects of radioiodine treatment on salivary gland function in patients with differentiated thyroid carcinoma: a prospective study. J Nucl Med 57:1685–1691. https://doi.org/10.2967/jnumed.115.169888CrossRef

25.

Selvakumar T, Nies M, Klein Hesselink MS, Brouwers AH, van der Horst-Schrivers ANA, Klein Hesselink EN, Tissing WJE, Vissink A, Links TP, Bocca G, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Smit JWA, Plukker JTM, Ronckers CM, van Santen HM (2018) Long-term effects of radioiodine treatment on salivary gland function in adult survivors of pediatric differentiated thyroid carcinoma. J Nucl Med. https://doi.org/10.2967/jnumed.118.212449CrossRefPubMed

26.

Daniel FI, Lima LD, Grando LJ, Castro R, Cordeiro EAK, Dos Santos CR (2017) Salivary evaluation in radioactive I131 treated patients with thyroid carcinoma. Acta Odontol Scand 76:148–152. https://doi.org/10.1080/00016357.2017.1399214CrossRefPubMed

27.

Walter MA, Turtschi CP, Schindler C, Minnig P, Müller-Brand J, Müller B (2007) The dental safety profile of high-dose radioiodine therapy for thyroid cancer: long-term results of a longitudinal cohort study. J Nucl Med 48:1620–1625. https://doi.org/10.2967/jnumed.107.042192CrossRefPubMed

28.

Jeong SY, Kim HW, Lee SW, Ahn BC, Lee J (2013) Salivary gland function 5 years after radioactive iodine ablation in patients with differentiated thyroid cancer: direct comparison of pre- and postablation scintigraphies and their relation to xerostomia symptoms. Thyroid 23(5):609–616. https://doi.org/10.1089/thy.2012.0106CrossRefPubMedPubMedCentral

29.

Bhayani MK, Acharya V, Kongkiatkamon S, Farah S, Roberts DB, Sterba J, Chambers MS, Lai SY (2015) Sialendoscopy for patients with radioiodine-induced sialadenitis and xerostomia. Thyroid 25:834–838. https://doi.org/10.1089/thy.2014.0572CrossRefPubMedPubMedCentral

30.

An YS, Yoon JK, Lee SJ, Song HS, Yoon SH, Jo KS (2013) Symptomatic late-onset sialadenitis after radioiodine therapy in thyroid cancer. Ann Nucl Med 27:386–391. https://doi.org/10.1007/s12149-013-0697-5CrossRefPubMed

31.

Lee HN, An JY, Lee KM, Kim EJ, Choi WS, Kim DY (2015) Salivary gland dysfunction after radioactive iodine (I131) therapy in patients following total thyroidectomy: emphasis on radioactive iodine therapy dose. Clin Imaging 39:396–400. https://doi.org/10.1016/j.clinimag.2014.12.018CrossRefPubMed

32.

Erkul E, Gillespie MB (2016) Sialendoscopy for non-stone disorders: the current evidence. Laryngoscope Investig Otolaryngol 1:140–145. https://doi.org/10.1002/lio2.33CrossRefPubMedPubMedCentral

33.

Lu L, Shan F, Li W, Lu H (2016) Short-term side effects after radioiodine treatment in patients with differentiated thyroid cancer. Biomed Res Int. https://doi.org/10.1155/2016/4376720CrossRefPubMedPubMedCentral

34.

Wu JQ, Feng HJ, Ouyang W, Sun YG, Chen P, Wang J, Xian JL, Huang LH (2015) Systematic evaluation of salivary gland damage following I131 therapy in differentiated thyroid cancer patients by quantitative scintigraphy and clinical follow-up. Nucl Med Commun 36:819–826. https://doi.org/10.1097/MNM.0000000000000325CrossRefPubMed

35.

De Luca R, Vicidomini A, Trodella M, Tartaro G, Colella G (2014) Sialoendoscopy: a viable treatment for I(131) induced sialoadenitis. Br J Oral Maxillofac Surg 52:641–646. https://doi.org/10.1016/j.bjoms.2014.01.025CrossRefPubMed

36.

Grewal RK, Larson SM, Pentlow CE, Pentlow KS, Gonen M, Qualey R, Natbony L, Tuttle RM (2009) Salivary gland side effects commonly develop several weeks after initial radioactive iodine ablation. J Nucl Med 50(10):1605–1610. https://doi.org/10.2967/jnumed.108.061382CrossRefPubMed

37.

Wu CB, Xi H, Zhou Q, Zhang LM (2015) Sialendoscopy-assisted treatment for radioiodine-induced sialadenitis. J Oral Maxillofac Surg 73:475–481. https://doi.org/10.1016/j.joms.2014.09.025CrossRefPubMed

38.

Almeida JP, Sanabria AE, Lima EN, Kowalski LP (2011) Late side effects of radioactive iodine on salivary gland function in patients with thyroid cancer. Head Neck 33:686–690. https://doi.org/10.1002/hed.21520CrossRefPubMed

39.

Upadhyaya A, Meng Z, Wang P, Zhang G, Jia Q, Tan J, Li X, Hu T, Liu N, Zhou P, Wang S, Liu X, Wang H, Zhang C, Zhao F, Yan Z (2017) Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer. Medicine (Baltimore) 96(25):e7164. https://doi.org/10.1097/MD.0000000000007164CrossRef

40.

Sasaki T, Nabaa B, Takahashi K, Okizaki A, Ishitoya S (2015) Non-contrast-enhanced computed tomography attenuation in the parotid glands before radioiodine therapy for thyroid carcinoma could be a predictor of radiovulnerability. Nucl Med Commun 36:350–355. https://doi.org/10.1097/MNM.0000000000000250CrossRefPubMed

41.

Jentzen W, Schneider E, Freudenberg L, Eising EG, Görges R, Müller SP, Brandau W, Bockisch A (2006) Relationship between cumulative radiation dose and salivary gland uptake associated with radioiodine therapy of thyroid cancer. Nucl Med Commun 8:669–676. https://doi.org/10.1097/00006231-200608000-00009CrossRef

42.

Fallahi B, Beiki D, Abedi SM, Saghari M, Fard-Esfahani A, Akhzari F, Mokarami B, Eftekhari M (2013) Does vitamin E protect salivary glands from I-131 radiation damage in patients with thyroid cancer? Nucl Med Commun 34:777–786. https://doi.org/10.1097/MNM.0b013e328362b1f2CrossRefPubMed

43.

Jonklaas J, Wang H, Esposito G (2015) Salivary function after radioiodine therapy: poor correlation between symptoms and salivary scintigraphy. Front Endocrinol (Lausanne) 6:100. https://doi.org/10.3389/fendo.2015.00100CrossRef

44.

Jo KS, An YS, Lee SJ, Soh EY, Lee J, Chung YS, Kim DJ, Yoon SH, Lee DH, Yoon JK (2014) Significance of salivary gland radioiodine retention on post-ablation (131)I scintigraphy as a predictor of salivary gland dysfunction in patients with differentiated thyroid carcinoma. Nucl Med Mol Imaging 48:203–211. https://doi.org/10.1007/s13139-014-0274-4CrossRefPubMedPubMedCentral

45.

Brozzi F, Rago T, Bencivelli W, Bianchi F, Santini P, Vitti P, Pinchera A, Ceccarelli C (2013) Salivary glands ultrasound examination after radioiodine-131 treatment for differentiated thyroid cancer. J Endocrinol Invest 36:153–156. https://doi.org/10.3275/8335CrossRefPubMed

46.

Nabaa B, Takahashi K, Sasaki T, Okizaki A, Aburano T (2012) Assessment of salivary gland dysfunction after radioiodine therapy for thyroid carcinoma using non-contrast-enhanced CT: the significance of changes in volume and attenuation of the glands. AJNR Am J Neuroradiol 33:1964–1970. https://doi.org/10.3174/ajnr.A3063CrossRefPubMedPubMedCentral

47.

Maruoka Y, Baba S, Isoda T, Kitamura Y, Abe K, Sasaki M et al (2017) A functional scoring system based on salivary gland scintigraphy for evaluating salivary gland dysfunction secondary to 131I therapy in patients with differentiated thyroid carcinoma. J Clin Diagn Res 11:TC23–TC28. https://doi.org/10.7860/JCDR/2017/27340.10431CrossRefPubMedPubMedCentral

48.

Ma C, Xie J, Jiang Z, Wang G, Zuo S (2010) Does amifostine have radioprotective effects on salivary glands in high-dose radioactive iodine-treated differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 37:1778–1785. https://doi.org/10.1007/s00259-009-1368-6CrossRefPubMed

49.

Edwards O, Yakish ED, Wang LM, Wu Q, Hoffman JM, Morton KA (2015) Histamine receptor 1 and 2 antagonists alter biodistribution of radioiodine. J Nucl Med Technol 43:214–219. https://doi.org/10.2967/jnmt.115.160697CrossRefPubMed

50.

Rosário PW, Borges MA, Purisch S (2008) Preparation with recombinant human thyroid-stimulating hormone for thyroid remnant ablation with 131I is associated with lowered radiotoxicity. J Nucl Med 49:1776–1782. https://doi.org/10.2967/jnumed.108.050591CrossRefPubMed

51.

Iakovou I, Goulis DG, Tsinaslanidou Z, Giannoula E, Katsikaki G, Konstantinidis I (2016) Effect of recombinant human thyroid-stimulating hormone or levothyroxine withdrawal on salivary gland dysfunction after radioactive iodine administration for thyroid remnant ablation. Head Neck 38(Suppl 1):E227-230. https://doi.org/10.1002/hed.23974CrossRefPubMed

52.

Hänscheid H, Lassmann M, Luster M, Thomas SR, Pacini F, Ceccarelli C, Ladenson PW, Wahl RL, Schlumberger M, Ricard M, Driedger A, Kloos RT, Sherman SI, Haugen BR, Carriere V, Corone C, Reiners C (2006) Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 47(4):648–654PubMed

53.

Kulkarni K, Van Nostrand D, Atkins F, Mete M, Wexler J, Wartofsky L (2014) Does lemon juice increase radioiodine reaccumulation within the parotid glands more than if lemon juice is not administered? Nucl Med Commun 35:210–216. https://doi.org/10.1097/MNM.0000000000000034CrossRefPubMed

54.

Jentzen W, Balschuweit D, Schmitz J, Freudenberg L, Eising E, Hilbel T, Bockisch A, Stahl A (2010) The influence of saliva flow stimulation on the absorbed radiation dose to the salivary glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging. Eur J Nucl Med Mol Imaging 37:2298–2306. https://doi.org/10.1007/s00259-010-1532-zCrossRefPubMed

55.

Jentzen W, Richter M, Nagarajah J, Poeppel TD, Brandau W, Dawes C, Bockisch A, Binse I (2014) Chewing-gum stimulation did not reduce the absorbed dose to salivary glands during radioiodine treatment of thyroid cancer as inferred from pre-therapy (124)I PET/CT imaging. EJNMMI Phys 1:100. https://doi.org/10.1186/s40658-014-0100-1CrossRefPubMedPubMedCentral

56.

Upadhyaya A, Zhou P, Meng Z, Wang P, Zhang G, Jia Q, Tan J, Li X, Hu T, Liu N, Wang S, Liu X, Wang H, Zhang C, Zhao F, Yan Z, Wang X, Zhang X, Zhang W (2017) Radioprotective effect of vitamin E on salivary glands after radioiodine therapy for differentiated thyroid cancer: a randomized-controlled trial. Nucl Med Commun 38:891–903. https://doi.org/10.1097/MNM.0000000000000727CrossRefPubMed

57.

Bhartiya US, Raut YS, Joseph LJ, Hawaldar RW, Rao BS (2008) Evaluation of the radioprotective effect of turmeric extract and vitamin E in mice exposed to therapeutic dose of radioiodine. Indian J Clin Biochem 23:382–386. https://doi.org/10.1007/s12291-008-0084-5CrossRefPubMedPubMedCentral

58.

Bhartiya US, Joseph LJ, Raut YS, Rao BS (2010) Effect of Ocimum sanctum, turmeric extract and vitamin E supplementation on the salivary gland and bone marrow of radioiodine exposed mice. Indian J Exp Biol 48:566–571PubMed

59.

Choi JS, An HY, Park IS, Kim SK, Kim YM, Lim JY (2016) Radioprotective effect of epigallocatechin-3 gallate on salivary gland dysfunction after radioiodine ablation in a murine model. Clin Exp Otorhinolaryngol 9:244–251. https://doi.org/10.21053/ceo.2015.01011CrossRefPubMedPubMedCentral

60.

Saylam G, Bayır Ö, Gültekin SS, Pınarlı FA, Han Ü, Korkmaz MH (2017) Protective/restorative role of the adipose tissue-derived mesenchymal stem cells on the radioiodine-induced salivary gland damage in rats. Radiol Oncol 51:307–316. https://doi.org/10.1515/raon-2017-0022CrossRefPubMedPubMedCentral

61.

Kim JW, Kim JM, Choi ME, Kim SK, Kim YM, Choi JS (2019) Adipose-derived mesenchymal stem cells regenerate radioiodine-induced salivary gland damage in a murine model. Sci Rep. https://doi.org/10.1038/s41598-019-51775-9CrossRefPubMedPubMedCentral

62.

Kim JW, Han GS, Lee SH, Lee DY, Kim YM (2007) Sialoendoscopic treatment for radioiodine induced sialadenitis. Laryngoscope 117:133–136. https://doi.org/10.1097/01.mlg.0000247776.72484.62CrossRefPubMed

63.

Prendes BL, Orloff LA, Eisele DW (2012) Therapeutic sialendoscopy for the management of radioiodine sialadenitis. Arch Otolaryngol Head Neck Surg 138:15–19. https://doi.org/10.1001/archoto.2011.215CrossRefPubMed

64.

Bomeli SR, Schaitkin B, Carrau RL, Walvekar RR (2009) Interventional sialendoscopy for treatment of radioiodine-induced sialadenitis. Laryngoscope 119:864–867. https://doi.org/10.1002/lary.20140CrossRefPubMed

65.

Geres AE, Mereshian PS, Fernández S, Rey Caro DG, Castro R, Podio R, Ojeda S (2015) Sialadenitis after radioiodine therapy. Analysis of factors that influence the response to medical treatment. Endocrinol Nutr 62:493–498. https://doi.org/10.1016/j.endonu.2015.07.006CrossRefPubMed

66.

Strychowsky JE, Sommer DD, Gupta MK, Cohen N, Nahlieli O (2012) Sialendoscopy for the management of obstructive salivary gland disease: a systematic reviewand meta-analysis. Arch Otolaryngol Head Neck Surg 138:541–547. https://doi.org/10.1001/archoto.2012.856CrossRefPubMed

67.

Canzi P, Cacciola S, Capaccio P, Pagella F, Occhini A, Pignataro L, Benazzo M (2017) Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis? Acta Otorhinolaryngol Ital 37:155–159. https://doi.org/10.14639/0392-100X-1606CrossRefPubMedPubMedCentral

Title: Sialadenitis as a complication of radioiodine therapy in patients with thyroid cancer: where do we stand?
Authors: Marios Adramerinas
Dimitrios Andreadis
Konstantinos Vahtsevanos
Athanasios Poulopoulos
Kalliopi Pazaitou-Panayiotou
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Inflammation of the Salivary Gland
Sialadenitis
Thyroid Cancer
Thyroid Cancer
Thyroid Cancer
Published in: Hormones / Issue 4/2021
Print ISSN: 1109-3099
Electronic ISSN: 2520-8721
DOI: https://doi.org/10.1007/s42000-021-00304-3

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