Abstract：
BACKGROUND: Thyroid carcinoma is the most common endocrine neoplasm. Multimodal therapy including surgery, radioactive iodine (RAI) therapy, and indefinite suppression of thyroid-stimulating hormone has led to an 85% cure rate in differentiated thyroid tumors (DTT). Approximately 5-10% of patients will have recurrence or metastases that have the potential to become resistant to RAI treatment.1 10-year overall survival rates are reported to be 10% in these patients versus 56% in patients with RAI avid disease.2 Lenvatinib, a multi-tyrosine-kinase inhibitor (TKI), was shown to have a 65% overall response rate in addition to a significant improvement in progression-free survival (PFS), approved to treat RAI-resistant DTTs.3, 4.
METHODS: We are reporting a very rare case of late renal toxicity in a 68-year-old woman with a history of type 2 diabetes and metastatic RAI-resistant follicular thyroid carcinoma (Hurthle cell variant) who developed thrombotic microangiopathy 21 months after initiation of treatment.
METHODS: It was determined that LEN should be held, due to worsening renal function secondary to TKI-induced kidney injury. Although the patient\'s renal function eventually improved and returned to her baseline after discontinuation of LEN, there was marked disease progression after drug cessation.
CONCLUSIONS: Renal toxicity is a rare adverse event (AE) that tends to occur typically within three weeks of initiation of treatment. The utilization of TKIs can lead to glomerulosclerosis, and careful considerations and precautions should be taken by clinicians who intend to initiate TKI therapy in patients with pre-existing diabetes to prevent renal toxicity.
METHODS: We are reporting a very rare case of late renal toxicity in a 68-year-old woman with a history of type 2 diabetes and metastatic RAI-resistant follicular thyroid carcinoma (Hurthle cell variant) who developed thrombotic microangiopathy 21 months after initiation of treatment.
METHODS: It was determined that LEN should be held, due to worsening renal function secondary to TKI-induced kidney injury. Although the patient\'s renal function eventually improved and returned to her baseline after discontinuation of LEN, there was marked disease progression after drug cessation.
CONCLUSIONS: Renal toxicity is a rare adverse event (AE) that tends to occur typically within three weeks of initiation of treatment. The utilization of TKIs can lead to glomerulosclerosis, and careful considerations and precautions should be taken by clinicians who intend to initiate TKI therapy in patients with pre-existing diabetes to prevent renal toxicity.
摘要：
背景：甲状腺癌是最常见的内分泌肿瘤。包括手术在内的多模式治疗，放射性碘（RAI）治疗，和无量抑制促甲状腺激素导致分化型甲状腺肿瘤（DTT）的治愈率为85％。大约5-10％的患者将有复发或转移，有可能对RAI治疗产生抗药性。1据报道，这些患者的10年总生存率为10％，而患有RAI狂热病的患者为56％。2Lenvatinib，多酪氨酸激酶抑制剂（TKI），除了无进展生存期（PFS）的显着改善外，还显示出65％的总体缓解率，批准治疗耐RAI的DTTs.3，4。
方法：我们报告了一例非常罕见的晚期肾毒性病例，该病例是一名68岁女性，有2型糖尿病和转移性RAI抵抗性滤泡性甲状腺癌（Hurthle细胞变异）病史，在开始治疗21个月后出现血栓性微血管病变。
方法：确定应持有LEN，由于肾功能恶化继发于TKI诱导的肾损伤。虽然患者的肾功能最终得到改善，并在停用LEN后恢复至基线，停药后有明显的疾病进展.
结论：肾毒性是一种罕见的不良事件（AE），通常在治疗开始后三周内发生。TKIs的使用会导致肾小球硬化，如果临床医师打算在已有糖尿病的患者中开始TKI治疗以预防肾毒性,则应谨慎考虑并采取预防措施.
方法：我们报告了一例非常罕见的晚期肾毒性病例，该病例是一名68岁女性，有2型糖尿病和转移性RAI抵抗性滤泡性甲状腺癌（Hurthle细胞变异）病史，在开始治疗21个月后出现血栓性微血管病变。
方法：确定应持有LEN，由于肾功能恶化继发于TKI诱导的肾损伤。虽然患者的肾功能最终得到改善，并在停用LEN后恢复至基线，停药后有明显的疾病进展.
结论：肾毒性是一种罕见的不良事件（AE），通常在治疗开始后三周内发生。TKIs的使用会导致肾小球硬化，如果临床医师打算在已有糖尿病的患者中开始TKI治疗以预防肾毒性,则应谨慎考虑并采取预防措施.
