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High Prevalence of Thyroid Disease and Role of Salivary Gland Scintigraphy in Patients with Xerostomia

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Abstract

Purpose

Although Sjögren’s syndrome (SS) is the most common disease causing xerostomia, autoimmune thyroid diseases can also affect the salivary glands. The aim of our study was to estimate the prevalence of thyroid diseases (TD) in subjects with symptoms of xerostomia and evaluate the efficacy of salivary gland scintigraphy (SGS) in the detection of TD in patients with SS and without SS.

Methods

We retrospectively reviewed the SGS findings of 173 subjects (men:women, 29:144) with symptoms of xerostomia. Ejection fractions (EF) in the parotid and submandibular glands were calculated. Thyroid disease was diagnosed on the basis of the results of the visual assessment of tracer uptake in the thyroid gland on SGS images as well as serological thyroid function tests.

Results

Based on the American-European Criteria, 94 patients were diagnosed with SS. Hashimoto’s thyroiditis was diagnosed in 63 patients, subacute thyroiditis in 23, subclinical hypothyroidism in five, and Graves’ disease in one. There were significant differences in the EF values of the parotid and submandibular glands between patients with TD and those with undetermined diagnoses.

Conclusions

More than half of patients with xerostomia exhibited TD. Thyroid assessment by SGS is feasible, and SGS appears to be useful for the patients with xerostomia caused by TD. SGS may be the first imaging modality capable of evaluating both salivary gland function and thyroid gland status in patients with xerostomia. This strategy would make the requirement for additional workup for thyroid disease.

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References

  1. Changlai SP, Chen WK, Chung C, Chiou SM. Objective evidence of decreased salivary function in patients with autoimmune thyroiditis (chronic thyroiditis, Hashimoto’s thyroiditis). Nucl Med Commun. 2002;23:1029–33.

    Article  CAS  PubMed  Google Scholar 

  2. Garg AK, Kirsh ER. Xerostomia: recognition and management of hypofunction of the salivary glands. Compend Contin Educ Dent. 1995;16(574):6–84. quiz 86.

    Google Scholar 

  3. Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:28–46.

    Article  CAS  PubMed  Google Scholar 

  4. Gupta A, Epstein JB, Sroussi H. Hyposalivation in elderly patients. J Can Dent Assoc. 2006;72:841–6.

    PubMed  Google Scholar 

  5. Mavragani CP, Fragoulis GE, Moutsopoulos HM. Endocrine alterations in primary Sjogren’s syndrome: an overview. J Autoimmun. 2012;39:354–8.

    Article  CAS  PubMed  Google Scholar 

  6. Kang JH, Lin HC. Comorbidities in patients with primary Sjogren’s syndrome: a registry-based case-control study. J Rheumatol. 2010;37:1188–94.

    Article  PubMed  Google Scholar 

  7. Alfaris N, Curiel R, Tabbara S, Irwig MS. Autoimmune thyroid disease and Sjogren syndrome. J Clin Rheumatol. 2010;16:146–7.

    Article  PubMed  Google Scholar 

  8. Robazzi TC, Adan LF. Autoimmune thyroid disease in patients with rheumatic diseases. Rev Bras Reumatol. 2012;52:417–30.

    Article  PubMed  Google Scholar 

  9. Lu MC, Yin WY, Tsai TY, Koo M, Lai NS. Increased risk of primary Sjogren’s syndrome in female patients with thyroid disorders: a longitudinal population-based study in Taiwan. PLoS One. 2013;8:e77210.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Tektonidou MG, Anapliotou M, Vlachoyiannopoulos P, Moutsopoulos HM. Presence of systemic autoimmune disorders in patients with autoimmune thyroid diseases. Ann Rheum Dis. 2004;63:1159–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Mavragani CP, Skopouli FN, Moutsopoulos HM. Increased prevalence of antibodies to thyroid peroxidase in dry eyes and mouth syndrome or sicca asthenia polyalgia syndrome. J Rheumatol. 2009;36:1626–30.

    Article  PubMed  Google Scholar 

  12. Kang JY, Jang SJ, Lee WW, Jang SJ, Lee YJ, Kim SE. Evaluation of salivary gland dysfunction using salivary gland scintigraphy in Sjogren’s syndrome patients and in thyroid cancer patients after radioactive iodine therapy. Nucl Med Mol Imaging. 2011;45:161–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wu CB, Xi H, Zhou Q, Zhang LM. The diagnostic value of technetium 99m pertechnetate salivary gland scintigraphy in patients with certain salivary gland diseases. J Oral Maxillofac Surg. 2015;73:443–50.

    Article  PubMed  Google Scholar 

  14. Taura S, Murata Y, Aung W, Ishida R, Zhang L, Hossain M, et al. Decreased thyroid uptake of Tc-99m pertechnetate in patients with advanced-stage Sjogren syndrome: evaluation using salivary gland scintigraphy. Clin Nucl Med. 2002;27:265–9.

    Article  PubMed  Google Scholar 

  15. Gune S, Yilmaz S, Karalezli A, Aktas A. Quantitative and visual evaluation of salivary and thyroid glands in patients with primary Sjogren’s syndrome using salivary gland scintigraphy: relationship with clinicopathological features of salivary, lacrimal and thyroid glands. Nucl Med Commun. 2010;31:666–72.

    PubMed  Google Scholar 

  16. Tensing EK, Nordstrom DC, Solovieva S, Schauman KO, Sippo-Tujunen I, Helve T, et al. Salivary gland scintigraphy in Sjogren’s syndrome and patients with sicca symptoms but without Sjogren’s syndrome: the psychological profiles and predictors for salivary gland dysfunction. Ann Rheum Dis. 2003;62:964–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Erhamamci S, Horasanli B, Aktas A. Assessment of the effect of interferon-beta1a therapy on thyroid and salivary gland functions in patients with multiple sclerosis using quantitative salivary gland scintigraphy. Mol Imaging Radionucl Ther. 2014;23:43–7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Smith JR, Oates E. Radionuclide imaging of the thyroid gland: patterns, pearls, and pitfalls. Clin Nucl Med. 2004;29:181–93.

    Article  PubMed  Google Scholar 

  19. Slatosky J, Shipton B, Wahba H. Thyroiditis: differential diagnosis and management. Am Fam Physician. 2000;61:1047–52.

  20. Wang PW, Chen HY, Li CH, Liu RT, Chien WY, Tung SC. Tc-99m pertechnetate trapping and thyroid function in Hashimoto’s thyroiditis. Clin Nucl Med. 1994;19:177–80.

    Article  CAS  PubMed  Google Scholar 

  21. Harbert JC, Eckelman WC, Neumann RD. Nuclear medicine: diagnosis and therapy. Thieme Medical Publishers, Stuttgart; 1996.

  22. Ahn D, Sohn JH, Jeon JH. Hypothyroidism following hemithyroidectomy: incidence, risk factors, and clinical characteristics. J Clin Endocrinol Metab. 2016;101:1429–36.

    Article  CAS  PubMed  Google Scholar 

  23. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bamba R, Sweiss NJ, Langerman AJ, Taxy JB, Blair EA. The minor salivary gland biopsy as a diagnostic tool for Sjogren syndrome. Laryngoscope. 2009;119:1922–6.

    Article  PubMed  Google Scholar 

  25. Umehara I, Yamada I, Murata Y, Takahashi Y, Okada N, Shibuya H. Quantitative evaluation of salivary gland scintigraphy in Sjorgen’s syndrome. J Nucl Med. 1999;40:64–9.

    CAS  PubMed  Google Scholar 

  26. Firat F, Cermik TF, Sarikaya A, Berkarda S. Effects of gender and age on the quantitative parameters of [99mTc]pertechnetate salivary gland scintigraphy in normal subjects. Nucl Med Commun. 2006;27:447–53.

    Article  PubMed  Google Scholar 

  27. Milic VD, Radunovic G, Boricic I, Ognjanovic S, Petrovic R, Radak-Perovic M, et al. High prevalence of autoimmune thyroid disease in subjects with sicca symptoms without Sjogren’s syndrome. Rheumatology (Oxford). 2013;52:754–5.

    Article  Google Scholar 

  28. Coll J, Anglada J, Tomas S, Reth P, Goday A, Millan M, et al. High prevalence of subclinical Sjogren’s syndrome features in patients with autoimmune thyroid disease. J Rheumatol. 1997;24:1719–24.

    CAS  PubMed  Google Scholar 

  29. Perez B, Kraus A, Lopez G, Cifuentes M, Alarcon-Segovia D. Autoimmune thyroid disease in primary Sjogren’s syndrome. Am J Med. 1995;99:480–4.

    Article  CAS  PubMed  Google Scholar 

  30. Ramos-Casals M, Garcia-Carrasco M, Cervera R, Gaya J, Halperin I, Ubieto I, et al. Thyroid disease in primary Sjogren syndrome. Study in a series of 160 patients. Medicine (Baltimore). 2000;79:103–8.

    Article  CAS  Google Scholar 

  31. Appenzeller S, Pallone AT, Natalin RA, Costallat LT. Prevalence of thyroid dysfunction in systemic lupus erythematosus. J Clin Rheumatol. 2009;15:117–9.

    Article  PubMed  Google Scholar 

  32. Grani G, Carbotta G, Nesca A, D’Alessandri M, Vitale M, Del Sordo M, et al. A comprehensive score to diagnose Hashimoto’s thyroiditis: a proposal. Endocrine. 2015;49:361–5.

    Article  CAS  PubMed  Google Scholar 

  33. Jara LJ, Navarro C, Brito-Zeron Mdel P, Garcia-Carrasco M, Escarcega RO, Ramos-Casals M. Thyroid disease in Sjogren’s syndrome. Clin Rheumatol. 2007;26:1601–6.

    Article  PubMed  Google Scholar 

  34. Caramaschi P, Biasi D, Caimmi C, Scambi C, Pieropan S, Barausse G, et al. The co-occurrence of Hashimoto thyroiditis in primary Sjogren’s syndrome defines a subset of patients with milder clinical phenotype. Rheumatol Int. 2013;33:1271–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI15C0001).

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Correspondence to Byeong-Cheol Ahn.

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Conflict of Interest

Ji-hoon Jung, Chang-Hee Lee, Seung Hyun Son, Ju Hye Jeong, Shin Young Jeong, Sang-Woo Lee, Jaetae Lee, Byeong-Cheol Ahn declare that they have no conflict of interest.

Ethical Statement

The study protocol had been approved by the Ethics Committee of the Kyungpook National University Hospital (KNUH 2016-03-034-002). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. No informed consent was needed, because of the retrospective design of our study.

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Jung, Jh., Lee, CH., Son, S.H. et al. High Prevalence of Thyroid Disease and Role of Salivary Gland Scintigraphy in Patients with Xerostomia. Nucl Med Mol Imaging 51, 169–177 (2017). https://doi.org/10.1007/s13139-016-0455-4

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  • DOI: https://doi.org/10.1007/s13139-016-0455-4

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