Publication: Tiroid karsinoma ve hipertiroidizm hastalarında tedavi amaçlı kullanılan I-131’in oral mukoza ve tükürük bezlerine erken dönem etkisinin klinik ve deneysel olarak incelenmesi
Abstract
Bu çalışmada tiroid karsinoma ve hipertiroidizm hastalarında tedavi amaçlı kullanılan I-131'in oral mukoza ve tükürük bezlerine erken dönem etkisinin klinik ve deneysel olarak incelenmesi amaçlanmıştır. Klinik çalışma yüksek doz I-131 tedavisine karar verilen 25 tiroid karsinoma ve 35 hipertiroidizm hastasında yapılmıştır. Hastalarda radyoaktif iyotun tükürük bezi fonksiyonlarına etkisini görmek amacıyla tedavi öncesi ve sonrası 1., 7., 30. günlerde sialometri ölçümleri alınmıştır. Tedavi öncesi ile sonrası 1., 7., 30. günlerdeki sialometri ortalamaları arasında yapılan istatistiksel değerlendirmede anlamlı sonuçlar bulunmuştur (p<0,05). Bu sonuçlar doğrultusunda I-131'in tükürük bezi fonksiyonlarını erken dönemde klinik olarak olumsuz yönde etkilediği, tedavi sonrası da oligosiali, xerostomi ve sialoadenitis gelişebildiği görülmüştür. Hastalarda tükürük bezi fonksiyon bozukluklarının yanı sıra boğazda kuruluk, ağız ve boğazda yanma, ağız kokusu ve tat alımında çeşitli oranlarda değişiklikler de gözlenmiştir. Deneysel çalışma 5'i kontrol, 25'i deney grubu olmak üzere toplam 30 albino erkek tavşanda yapılmıştır. Tavşanlara kg başına 1,5 mCi I-131 verildikten sonra 1. , 5., 10., 15., 30. günlerde majör tükürük bezleri ve oral mukozanın minör tükürük bezlerinden örnekler alınmıştır. Alınan örneklerden gr başına I-131'in % tutulumu hesaplanmıştır. Minör tükürük bezlerinde 1. gün dışında, majör tükürük bezlerinde 5. günden sonra tutulumun anlamlı olmadığı görülmüştür. Örnekler daha sonra rutin doku takiplerinden geçirilip elde edilen kesitler H&E ve PAS boyama yöntemleri ile boyanıp, ışık mikroskobunda incelenmiştir. Histopatolojik inceleme sonucu majör ve oral mukoza minör tükürük bezlerinin, özellikle de seröz hücrelerin I-131'den etkilendiği tespit edilmiştir. Oral mukoza minör tükürük bezlerinin çok kısa sürede etkilenip, 30 gün içinde mikst yapıdan tamamen müköz yapıya geçmesi dikkati çekmiştir. Çalışmada klinik ve deneysel bulguların sonuçlarında paralellik görülmüştür. Yüksek doz I-131 uygulaması sonucu tükürük bezlerinde erken dönemde hücresel düzeyde morfolojik değişiklikler oluşabildiği, seröz bezlerin etkilendiği, tükürük bezlerinin müköz karekter kazanabildiği, parankimal ve fonksiyonel hasarların meydana gelebildiği, oligosiali, xerostomi ve sialoadenitis gelişebildiği sonucuna varılmıştır. AN EXPERIMENTAL INVESTIGATION ABOUT THE EARLY EFFECTS ON THE ORAL MUCOSA AND SALIVARY GLANDS OF TYROID CARCINOMA AND HYPERTYROIDISM PATIENTS BY APPLYING I-131
The aim of the study is the clinical and experimental investigation about the early effects on the oral mucosa and salivary glands of tyroid carcinoma and hypertyroidism patients by applying I-131. The clinical study is executed on 25 tyroid carcinoma patients by giving them a high doses of I-131. In order to see the effects of radioiodine on the salivary glands, sialometry measurements were performed on the 1st, 7th, and 30th days. The difference between the average sialometry values of the statistical studies before and after the treatment were significant (p<0,05). According to these statistical results, in early period negative effects of I-131 on the salivary glands were observed and after the treatment of oligosialia, xerostomia and sialoadenitis were able to develop. Besides the salivary gland disfunction, dry throat, burning mouth and sore throat , halitosis and different taste levels were observed. The experimental study has been carried out on 30 albino male rabbits, 5 of which were used for control and 25 for the experimental group. After 1,5 mCi I-131 has been given per kg. to each rabbit, samples have been taken on the 1st, 5th, 10th, 15th and 30th days from the major salivary glands and the minor salivary glands of the oral mucosa. The percent uptake of I-131 per gr. has been calculated from the samples taken. It has been observed that the uptake was not significant except for the 1st day on the minor salivary glands and the 5th day on the major salivary glands. The samples have been examined through the routine tissue tracing and the sections have been coloured with HE and PAS colouring techniques and examined with the optical microscope. After the histopathological observation, it has been concluded that the major and minor salivary glands of oral mucosa, especially serous cells were effected from I-131. It has been noticed that the minor salivary glands of oral mucosa have been instantly effected and converted from the mixed structure to the mucous structure in 30 days time. At the end of the study, the results of the clinical and the experimental findings have been found in parallel. After the application of high doses of I-131 the following findings have been concluded; morphological transformation in the salivary glands in early period, effecttion of serous glands and transformation to mucous of the salivary glands, parancimal and functional damage, oligosialia, xerostomia and sialoadenitis.
The aim of the study is the clinical and experimental investigation about the early effects on the oral mucosa and salivary glands of tyroid carcinoma and hypertyroidism patients by applying I-131. The clinical study is executed on 25 tyroid carcinoma patients by giving them a high doses of I-131. In order to see the effects of radioiodine on the salivary glands, sialometry measurements were performed on the 1st, 7th, and 30th days. The difference between the average sialometry values of the statistical studies before and after the treatment were significant (p<0,05). According to these statistical results, in early period negative effects of I-131 on the salivary glands were observed and after the treatment of oligosialia, xerostomia and sialoadenitis were able to develop. Besides the salivary gland disfunction, dry throat, burning mouth and sore throat , halitosis and different taste levels were observed. The experimental study has been carried out on 30 albino male rabbits, 5 of which were used for control and 25 for the experimental group. After 1,5 mCi I-131 has been given per kg. to each rabbit, samples have been taken on the 1st, 5th, 10th, 15th and 30th days from the major salivary glands and the minor salivary glands of the oral mucosa. The percent uptake of I-131 per gr. has been calculated from the samples taken. It has been observed that the uptake was not significant except for the 1st day on the minor salivary glands and the 5th day on the major salivary glands. The samples have been examined through the routine tissue tracing and the sections have been coloured with HE and PAS colouring techniques and examined with the optical microscope. After the histopathological observation, it has been concluded that the major and minor salivary glands of oral mucosa, especially serous cells were effected from I-131. It has been noticed that the minor salivary glands of oral mucosa have been instantly effected and converted from the mixed structure to the mucous structure in 30 days time. At the end of the study, the results of the clinical and the experimental findings have been found in parallel. After the application of high doses of I-131 the following findings have been concluded; morphological transformation in the salivary glands in early period, effecttion of serous glands and transformation to mucous of the salivary glands, parancimal and functional damage, oligosialia, xerostomia and sialoadenitis.