Thyroid function tests (TFTs) abnormalities in patients (pts) with metastatic renal cell carcinoma (mRCC) treated with sunitinib

4605 Background: Sunitinib is a multi-targeted receptor tyrosine kinase inhibitor of vascular endothelial growth factor and platelet-derived growth factor receptors. It has anti-tumor activity in mRCC pts with toxicity including fatigue. We investigated TFTs abnormalities and related signs and symptoms in pts with mRCC receiving sunitinib. Methods: The medical records of pts with mRCC enrolled in 4 ongoing clinical trials of sunitinib were reviewed. TFTs assessment (TSH, T3 and T4) was undertaken based on the clinical suspicion of treating physicians. Patient demographics, frequency and values of TFTs and any signs and symptoms of thyroid dysfunction were collected. Abnormal TFTs and treatment outcome were correlated. Results: Between 5/2004 and 12/2005, 62 pts (43 males, 19 females) were treated with sunitinib. The median age was 58 years (range, 23–72). Fifty-five pts had TFTs assessed while on treatment and 40 pts (65% of total) had one or more abnormality. Two pts had well-controlled hypothyroidism prior to initiation of sunitinib. TFTs abnormalities were consistent with hypothyroidism in all pts including one who initially developed transient hyperthyroidism. Signs and symptoms possibly related to hypothyroidism were found in 33 pts (53% of total) with abnormal TFTs and were initially attributed to sunitinib. Signs and symptoms included fatigue in 33 pts, anorexia in 20 pts, fluid retention in 17 pts, and skin/hair changes in 13 pts. Thyroid hormone replacement was undertaken in 12 pts and resulted in improvement of symptoms in 6 pts. Among the 40 pts with abnormal TFTs 29 pts had tumor evaluation; 13 had SD, 8 had PR, 2 had CR. There was no correlation between abnormal TFTs and treatment outcome. Conclusions: TFTs abnormalities are common in pts with mRCC treated with sunitinib. Thyroid hormone replacement is indicated in such pts to improve hypothyroidism-related symptoms and possibly to improve treatment tolerance. [Table: see text]

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MON-499 Nivolumab-Induced Hypothyroidism Is Irreversible in Most Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1577 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jee Hee Yoon ◽

Ji Yong Park ◽

A Ram Hong ◽

Hee Kyung Kim ◽

Ho-Cheol Kang

Keyword(s):

Hormone Replacement Therapy ◽

Thyroid Hormone ◽

Replacement Therapy ◽

Cancer Patients ◽

Thyroid Dysfunction ◽

Clinical Course ◽

Hormone Replacement ◽

Thyroid Function Tests ◽

Thyroid Hormone Replacement ◽

Thyroid Hormone Replacement Therapy

Abstract Background Thyroid dysfunction caused by the immune checkpoint inhibitor (ICPI) is common, however mild dysthyroidism could occur easily in cancer patients due to other causes. The aim of this study was to investigate the incidence and clinical course of ICPI-induced hypothyroidism requiring thyroid hormone replacement. Patients and methods We analyzed baseline and follow up thyroid function tests of cancer patients treated with nivolumab between March 2016 and March 2019 at Chonnam University Hwasun Hospital retrospectively. Results Among 265 cancer patients treated with nivolumab therapy, six patients were excluded from the study because they were on thyroid hormone replacement therapy before starting nivolumab therapy. Twenty-one patients (8.1%) newly developed thyroid dysfunction during nivolumab therapy and sixteen patients (6.2%) required thyroid hormone replacement therapy due to drug-induced hypothyroidism. Cancer diagnoses included lung cancer (n=7), renal cell carcinoma (n=4), malignant melanoma (n=2), hepatocellular carcinoma (n=2), and esophageal cancer (n=1). Six patients (37.5%) showed thyrotoxic phase prior to overt hypothyroidism and the others (n=10, 62.5%) revealed hypothyroidism without thyrotoxic phase. Most ICPI-induced hypothyroidism was irreversible, only one patient was able to discontinue thyroid hormone replacement after quitting nivolumab therapy. Conclusion A significant number of patients treated with nivolumab developed ICPI-induced hypothyroidism requiring thyroid hormone replacement and its clinical course was irreversible in most patients.

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Interfering Medications in Older Adults on Thyroid Hormone Replacement: Who Is at Risk?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1694 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A831-A831

Author(s):

Rachel Beeson ◽

Antoinette B Coe ◽

David Reyes-Gastelum ◽

Megan R Haymart ◽

Maria Papaleontiou

Keyword(s):

Older Adults ◽

Thyroid Hormone ◽

Thyroid Function ◽

Hormone Replacement ◽

Patient Characteristics ◽

Population Based ◽

Thyroid Function Tests ◽

Thyroid Hormone Replacement ◽

Function Tests ◽

Concurrent Use

Abstract Background: Thyroid hormone prescriptions have steadily increased in the past few years with levothyroxine being one of the most frequently prescribed medications in the United States. Population-based studies have shown that older age is a significant predictor for thyroid hormone initiation, with use continuing long-term. Thyroid hormone management in older adults is complicated by the presence of comorbidities and polypharmacy, particularly due to medications that can interfere with thyroid function tests. However, the prevalence of concurrent use of thyroid hormone and interfering medications in older adults and patient characteristics associated with this practice remain unknown. Methods: We conducted a population-based, retrospective cohort study of 538,137 thyroid hormone users aged ≥65 years from the Corporate Data Warehouse of the Veterans Health Administration (2004-2017). First, we described the prevalence of concurrent use of thyroid hormone and medications that commonly interfere with thyroid function tests (i.e., prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, amiodarone, lithium, interferon-alpha, tamoxifen). Then, we performed a multivariable logistic regression analysis to determine patient characteristics associated with concurrent use of thyroid hormone and at least one interfering medication during the study period. Covariates included in the model were patient age, sex, race, ethnicity and number of comorbidities. Results: Overall, 170,261 (31.6%) of patients were on at least one interfering medication while on thyroid hormone during the study period (median follow up 56 months). Non-white race [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.15-1.21], compared to white race), Hispanic ethnicity (OR 1.11, 95% CI 1.08-1.14, compared to non-Hispanic), female sex (OR 1.12, 95% CI 1.08-1.15, compared to male sex), and presence of comorbidities (e.g. Charlson-Deyo Comorbidity Score ≥2, OR 2.47, 95% CI 2.43-2.52, compared to zero) were more likely to be associated with concurrent use of thyroid hormone and interfering medications. Older age (e.g., ≥85 years, OR 0.47, 95% CI 0.46 - 0.48, compared to age 65-74 years) was less likely to be associated with concurrent use of thyroid hormone and interfering medications. Conclusions: Almost one-third of older adults on thyroid hormone were taking medications that have been known to interfere with thyroid function tests. Our study highlights the complexity of managing thyroid hormone replacement in older patients, many of whom are at risk for adverse effects in the context of polypharmacy and comorbidities.

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Severe Hypothyroidism Complicated by Myopathy and Neuropathy with Atypical Demyelinating Features

Case Reports in Endocrinology ◽

10.1155/2021/5525156 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Malgorzata Monika Brzozowska ◽

Shraddha Banthia ◽

Simon Thompson ◽

Manisha Narasimhan ◽

James Lee

Keyword(s):

Thyroid Hormone ◽

Lower Limb ◽

Nerve Conduction ◽

Hormone Replacement ◽

Nerve Conduction Studies ◽

Lower Limbs ◽

Thyroid Function Tests ◽

Neurological Manifestations ◽

Thyroid Hormone Replacement ◽

Autoimmune Hypothyroidism

Autoimmune hypothyroidism may result in a wide range of neuromuscular disorders. The frequently observed neurological manifestations of acquired hypothyroidism include mild to moderate myopathy and sensorimotor neuropathy, which usually resolve by clinical and electrophysiological criteria, in adults treated with thyroid hormone replacement. We report a case of a 30-year-old male with severe hypothyroidism secondary to chronic autoimmune thyroiditis who presented with a 2-year history of progressive fatigue, upper and lower limb weakness, myalgia, and intermittent paraesthesia. His neurological exam demonstrated proximal and distal muscle weakness, lower limb areflexia, and relatively intact sensory modalities. The patient’s biochemistry revealed unusually and profoundly raised the thyroid stimulating hormone (TSH) level of 405.5 mIU/L (reference range (RR): 0.27–4.2 mIU/L) and creatine kinase (CK) level of 20,804 U/L (RR: 45–250 U/L), while his nerve conduction studies (NCS) demonstrated severe sensorimotor polyneuropathy with both axonal and demyelinating features. Thyroid hormone replacement therapy over the first 3 months resulted in biochemical normalization of his extremely deranged thyroid function tests (TFTs) and CK levels. At 12 months, despite maintaining euthyroidism and noticeable improvement in strength, his nerve conduction studies (NCS) demonstrated the continued absence of distal motor and sensory responses in his lower limbs with only partial improvement in sensory amplitudes and conduction velocities in his upper limbs. This report highlights the potential for severe neuromuscular consequences from advanced and chronic autoimmune hypothyroidism. The patient’s myopathy has resolved over a period of three months with prompt normalization of CK levels. Concerningly, the patient achieved significant but incomplete recovery from his mixed axonal and demyelinating neuropathy with residual mild distal weakness and areflexia in his lower limbs and persistent motor and sensory impairments on his NCS. The severity and incomplete resolution of our patient’s neurological manifestations emphasize the importance of early diagnosis and the need for prompt therapeutic intervention for hypothyroidism.

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Echocardiographic Evaluation of Diastolic Dysfunction in Patients with Subclinical Hypothyroidism & the effect of L-Thyroxine treatment: A hospital based study

Nepalese Heart Journal ◽

10.3126/njh.v11i1.10979 ◽

2014 ◽

Vol 11 (1) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Prahlad Karki ◽

Ila Pandey ◽

Sangita Bhandary ◽

Madhab Lamsal ◽

Nikesh Raj Shrestha

Keyword(s):

Hormone Replacement Therapy ◽

Thyroid Hormone ◽

Pericardial Effusion ◽

Diastolic Dysfunction ◽

Replacement Therapy ◽

Subclinical Hypothyroidism ◽

Hormone Replacement ◽

Thyroid Function Tests ◽

Thyroid Hormone Replacement ◽

Thyroid Hormone Replacement Therapy

Background & Aims: Diastolic dysfunction is the common condition with Subclinical Hypothyroidism and is reversible in many cases after treatment. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy in patients of Subclinical Hypothyroidism. Methods: Forty newly diagnosed cases of Subclinical Hypothyroidism (38 females and 2 males) and age more than 18 years were included. Diagnosis was made on the basis of history, clinical examination and thyroid function tests. Echocardiography was performed in all and was repeated after 4-6 months in those who had diastolic dysfunction. Distribution of Diastolic dysfunction among the involved cases and their response to treatment with L-thyroxine were studied. Results: The diastolic dysfunction was found in 15 (37.5%) and pericardial effusion (PE) in five (12.5%) patients. Fourteen of them had impaired relaxation abnormality and only one patient had pseudonormal pattern. With replacement therapy, 13 reverted back to the normal whereas one having grade 2 diastolic dysfunction (pseudonormal pattern) reverted to grade 1. One patient who had grade 1 diastolic dysfunction (impaired relaxation) did not improve. Pericardial effusion subsided in all 5 cases. Conclusions: Echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with Subclinical Hypothyroidism. Our findings suggest that Thyroid Hormone Replacement Therapy may reverse diastolic dysfunction in Subclinical Hypothyroidism. DOI: http://dx.doi.org/10.3126/njh.v11i1.10979 Nepalese Heart Journal 2014;11(1): 33-38

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Van Wyk-Grumbach syndrome with hemangioma in an infant

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0049 ◽

2018 ◽

Vol 31 (9) ◽

pp. 1057-1060

Author(s):

Moumita Biswas ◽

Malay Kumar Sinha ◽

Mrinal Kanti Das ◽

Sumantra Sarkar

Keyword(s):

Thyroid Hormone ◽

Congenital Hypothyroidism ◽

Hormone Replacement ◽

Signs And Symptoms ◽

Bone Age ◽

Infantile Hemangioma ◽

Thyroid Stimulating Hormone ◽

High Serum ◽

Primary Hypothyroidism ◽

Thyroid Hormone Replacement

Abstract Background Van Wyk-Grumbach syndrome (VWGS) is characterized by juvenile primary hypothyroidism, delayed bone age and isosexual incomplete precocious puberty with reversal to the prepubertal state following thyroid hormone replacement. Case presentation In this case, an 18-month-old girl presented with premature menarche since 9 months of age, delayed bone age and enlarged bilateral multicystic ovaries along with a superficial infantile hemangioma over the upper anterior chest. VWGS was diagnosed based on the clinical features. High serum thyroid stimulating hormone and low free thyroxine with the absence of any carpal bones in the wrist X-ray were suggestive of congenital hypothyroidism. Interestingly, the coexisting hemangioma could also play a role in the etiology of the hypothyroidism through “consumptive hypothyroidism”. Thyroid hormone replacement resulted in the complete resolution of signs and symptoms. Conclusions Untreated congenital hypothyroidism of short duration, onset of symptoms in infancy and association of an infantile hemangioma in VWGS were the unique features in our case.

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Linear modulation of serum thyrotrophin by thyroid hormone treatment in hypothyroidism

Acta Endocrinologica ◽

10.1530/acta.0.0950472 ◽

1980 ◽

Vol 95 (4) ◽

pp. 472-478 ◽

Cited By ~ 6

Author(s):

A. Eugene Pekary ◽

Jerome M. Hershman ◽

Clark T. Sawin

Keyword(s):

Thyroid Hormone ◽

Hormone Replacement ◽

Hormone Treatment ◽

Significant Negative Correlation ◽

Thyroid Hormone Replacement ◽

Basal Serum ◽

Thyroid Hormone Levels ◽

Peak Versus ◽

Hypothyroid Patients ◽

Serum Tsh

Abstract. Basal serum TSH and the peak TSH response to a 500 μg TRH bolus were measured in 57 euthyroid and in 29 hypothyroid subjects either receiving graded thyroid hormone replacement or acutely removed from full replacement therapy. Serum TSH, total T4 and T3 were determined by sensitive radioimmunoassay methods. The peak versus basal TSH data for hypothyroid patients were linear within individuals. The regression slope of the peak versus basal TSH data for all hypothyroid subjects did not differ significantly from the corresponding slope for all euthyroid subjects. Basal and peak TSH versus T3 and T4 data for hypothyroid patients were also linear within each individual. Moreover, the regression of the basal TSH values averaged over the non-replacement to full replacement state against the TSH versus T3 slope had a significant negative correlation. This trend leads to an array of regression lines which average to the familiar hyperbolic relationship between thyrotrophin and thyroid hormone levels in man.

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