Consumptive hypothyroidism in patient with previous primary hypothyroidism

Modino, Soralla Civantos; Delgado, María Santiaga Pacheco; Muñoz, Juan A.; Minchot, Emilia Cancer; Molina, Gloria Cánovas; Robles, Azucena Rodríguez

doi:10.1016/j.endien.2021.02.001

Cited by 1 publication

(1 citation statement)

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“…In contrast, among the six cases in adults, four had solid nonvascular tumors (gastrointestinal stromal tumor (GIST) ( n = 2) or fibrous tumors ( n = 2)) ( 3 , 5 , 10 , 11 ). Since 2017, this paraneoplastic condition has been reported in another 11 pediatric patients with hemangiomas, but only two additional adults, one with a GIST ( 4 ) and one with a hemangiopericytoma ( 12 ). In addition to the high thyroid hormone requirements with characteristic thyroid function tests, the diagnosis can be confirmed by demonstrating overexpression of D3.…”

Section: Discussionmentioning

confidence: 99%

Consumptive hypothyroidism in a patient with malignant rhabdoid tumor of the kidney: case report on a newly found association

Fiore

Rosa

Uccella

et al. 2022

European Thyroid Journal

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Introduction: Consumptive hypothyroidism is a rare paraneoplastic condition most commonly associated with infantile hemangiomas. It is caused by overexpression of deiodinase type 3 (D3), which leads to preferential conversion of thyroxine to the metabolically inactive reverse triiodothyronine (rT3), paralleled by a decrease of the biologically active T3. Case presentation: A 46-year-old male patient with previously normal thyroid function was diagnosed with a renal carcinoma with rhabdoid differentiation. He was treated with sunitinib, followed by the immune checkpoint inhibitors ipilimumab and nivolumab, and he developed primary hypothyroidism secondary to thyroiditis. Substitution with unusually high doses of levothyroxine as high as 4.3 µg/kg/day did not normalize his thyroid function. Poor compliance was refuted because there was no improvement after observed administration. He had no malabsorption. Although tyrosine kinase inhibitors can increase the expression of D3, this effect tends to be modest. Therefore, the suspicion of tumor-related consumptive hypothyroidism was raised and supported by low free T3 and elevated rT3 levels. The therapy could not be further modified because the patient opted for palliative care and passed twelve days later. Immunohistochemistry of the tumor from a sample obtained prior to systemic therapy documented abundant expression of D3 corroborating the diagnosis of consumptive hypothyroidism. Conclusions: This observation extends the spectrum of malignancies overexpressing D3. Although rare, increased awareness for this paraneoplastic syndrome is key, if persistent hypothyroidism cannot be explained by compliance issues or malabsorption. Substitution with high doses of levothyroxine, and combination therapy with liothyronine, can correct hypothyroidism in these patients.

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