Abstract

Background: Radioiodine therapy (RAIT) remains a cornerstone in the management of differentiated thyroid cancer, however the salivary gland toxicity associated with RAIT is an under-recognized yet clinically relevant complication. Patients may develop a spectrum of manifestations ranging from acute sialadenitis to chronic xerostomia, with substantial impact on quality of life and long-term oral health. The 2025 American Thyroid Association guidelines acknowledge salivary gland dysfunction as a potential adverse effect of RAIT and emphasize patient counselling and preventive measures such as hydration. However, detailed, evidence-based protocols for prevention and management are not clearly outlined. This review summarizes current guideline recommendations and available evidence regarding prevention and management strategies, including hydration, sialogogues, pharmacologic agents such as pilocarpine, and emerging interventions like sialendoscopy. It further highlights gaps between guideline recommendations and real-world practice, particularly in resource-limited settings. The aim is to provide a concise, clinically applicable framework for nuclear medicine physicians managing radioiodine-induced salivary gland dysfunction.

Key words: Key words: Salivary gland dysfunction, radioiodine therapy (RAIT), differentiated thyroid cancer, acute sialadenitis, chronic xerostomia, sialendoscopy.