Clinical characteristics of thyroid abnormalities induced by sunitinib treatment in Japanese patients with renal cell carcinoma

Sato, Shuichi; Muraishi, Kazuhisa; Tani, Junichi; Sasaki, Yuko; Tokubuchi, Ichiro; Tajiri, Yuji; Yamada, Kentaro; Suekane, Shigetaka; Miyajima, Jiro; Matsuoka, Kei; Hiromatsu, Yuji

doi:10.1507/endocrj.k10e-130

Cited by 35 publications

(23 citation statements)

References 15 publications

(41 reference statements)

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“…Several mechanisms for TKI-induced thyroid dysfunction have been proposed, including induction of destructive thyroiditis, inhibition of thyroid peroxidase activity, effects on thyroid hormone absorption and clearance, impaired iodide uptake, and thyroid capillary regression caused by vascular endothelial growth factor inhibition [102, 106, 107]. Destructive thyroiditis is likely a major mechanism, and this follows a typical pattern of hyperthyroidism followed by hypothyroidism [102, 110, 111]. In a large study of TKI-treated adult patients, Lechner et al[108] found that nearly 40% of previously euthyroid patients developed either subclinical or overt hypothyroidism; the odds were greatest within the first 6 months on a TKI and in female patients.…”

Section: Thyroid Dysfunction Due To Non-radioactive Systemic Therapiesmentioning

confidence: 99%

Thyroid Sequelae of Pediatric Cancer Therapy

Waguespack

2018

Horm Res Paediatr

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The hypothalamic-pituitary-thyroid axis is a common site of unintended, acquired disease either during or after the treatment of cancer. Children treated with external radiation therapy are at the highest risk for developing a thyroid-related late effect, but thyroid dysfunction and second primary thyroid neoplasms can also occur after treatment with radiopharmaceutical agents such as ¹³¹I-metaiodobenzylguanidine. Increasingly recognized is the development of early thyroid dysfunction as an off-target consequence of the more novel cancer therapeutics such as the tyrosine kinase inhibitors and immune checkpoint inhibitors. Thyroid sequelae resulting from irradiation may manifest only after years to decades of follow-up, and their resultant clinical symptoms may be indolent and non-specific. Therefore, lifelong monitoring of the childhood cancer survivor at risk for thyroid disease is paramount. In this comprehensive review, the myriad thyroid adverse effects resulting from pediatric cancer treatment are discussed and an overview of screening and treatment of these thyroid sequelae provided.

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Section: Thyroid Dysfunction Due To Non-radioactive Systemic Therapiesmentioning

confidence: 99%

Thyroid Sequelae of Pediatric Cancer Therapy

Waguespack

2018

Horm Res Paediatr

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“…Destructive thyroiditis and/or drug-induced thyroid atrophy have been suggested as possible explanations. The findings of transient periods of hyperthyroidism [4,[21][22][23][24] and the absence [4] or shrinkage [24,25] of thyroid tissue on ultrasound that have been observed in some patients treated with sunitinib support these mechanisms.…”

Section: Proposed Mechanisms Of Tki-induced Hypothyroidismmentioning

confidence: 78%

Tyrosine kinase inhibitor-induced hypothyroidism: incidence, etiology, and management

Brown

2011

Targ Oncol

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In recent years, tyrosine kinase inhibitors (TKIs) have emerged as a new class of anti-cancer therapy with proven efficacy in several types of carcinoma. Although generally considered less toxic than cytotoxic chemotherapy, TKIs do have significant side effects including fatigue and hypertension. In addition, TKI-induced thyroid dysfunction is now recognized as a common toxicity that is associated with some TKI inhibitors. Detection of TKI-induced thyroid dysfunction requires routine monitoring of thyroid function and, in some cases, may require treatment. This review provides a comprehensive assessment of literature evaluating TKI-induced thyroid dysfunction, focusing on the potential mechanisms that result in this toxicity, whether the development of thyroid dysfunction is clinically meaningful, and controversies regarding treatment with thyroid hormone therapy.

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“…Sato et al observed sunitinib-induced destructive thyroiditis in seven of eight RCC patients when the thyroid function was frequently monitored. The authors suggest that sunitinib-induced hypothyroidism may be a consequence of preceding thyroiditis with associated transient thyrotoxicosis (11).…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Adrenal Insufficiency Unmasked During Sunitinib Treatment for Metastatic Renal Cell Carcinoma

Yoshino

Kawai

Miyazaki

et al. 2012

Japanese Journal of Clinical Oncology

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Sunitinib has recently become a standard treatment for metastatic renal cell carcinoma. However, various adverse events have been reported. We present the first case of clinically evident adrenal insufficiency during sunitinib therapy. A 72-year-old man began sunitinib therapy for bilateral lung and adrenal metastases of renal cell carcinoma. His adrenocorticotrophic hormone level was 93.6 pg/ml (7.2 -63.3 pg/ml) before sunitinib treatment, indicating that subclinical adrenal insufficiency already existed. Fatigue, which is a frequently seen adverse effect of sunitinib treatment, emerged acutely on Day 24 of the second cycle. Adrenocorticotrophic hormone and free T4 were high and thyroid-stimulating hormone was suppressed. Under the clinical diagnosis of acute adrenal insufficiency with thyrotoxicosis, a low dose of steroid was administered. Fatigue was completely ameliorated by the following morning, although free T4 was still high and thyroid-stimulating hormone was still low. Therefore, hypermetabolism due to thyrotoxicosis unmasked adrenal insufficiency in our case. Physicians should be aware of this rare but potentially fatal complication when severe acute fatigue develops in patients with subclinical adrenal insufficiency.

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Clinical characteristics of thyroid abnormalities induced by sunitinib treatment in Japanese patients with renal cell carcinoma

Cited by 35 publications

References 15 publications

Thyroid Sequelae of Pediatric Cancer Therapy

Thyroid Sequelae of Pediatric Cancer Therapy

Tyrosine kinase inhibitor-induced hypothyroidism: incidence, etiology, and management

A Case of Acute Adrenal Insufficiency Unmasked During Sunitinib Treatment for Metastatic Renal Cell Carcinoma

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