■酪氨酸激酶抑制剂(TKIs)是与甲状腺激素需求增加和脱碘酶活性改变相关的化学治疗剂。我们提出了第一个将这些发现与TKIibrutinib联系起来的案例。
■系列促甲状腺激素(TSH),游离甲状腺素(FT4),游离三碘甲状腺原氨酸(FT3),和反向三碘甲状腺原氨酸(rT3)水平进行评估。
■一位80岁的老人,62公斤的女性甲状腺功能减退,继发于甲状腺全切除术治疗I期甲状腺乳头状癌,每天维持左甲状腺素(LT4)137μg,提交后续。与前一年相比,服用泮托拉唑时,患者体重增加2kg,TSH从2.58μIU/mL增加至27.60μIU/mL(正常:0.45-4.50μIU/mL).伊布替尼,她的其他药物,7个月前开始治疗慢性淋巴细胞白血病。尽管依次确认了适当的LT4依从性和自我给药,将LT4调整为150μg,停药泮托拉唑,病人的甲状腺功能减退症状恶化,6个月后TSH为73.90μIU/mL。LT4每周六天增加到175μg,每周一次增加到262.5μg。两个月后,TSH为3.92μIU/mL(稳态条件),FT42.32ng/dL(正常:0.82-1.77ng/dL),FT31.6pg/mL(正常:2.0-4.4pg/mL),rT3为69.6ng/dL(正常:9.2-24.1ng/dL)。由于胃肠道副作用和血压升高,依鲁替尼在下个月停药。四个月后,LT4已降至150μg,FT4达到1.92ng/dL,FT32.0pg/mL,和rT326.6ng/dL。
■该报告将依鲁替尼与甲状腺切除妇女的甲状腺激素需求增加联系起来,该妇女的T3:T4,T3:rT3和T4:rT3比率降低提示3型脱碘酶诱导和2型脱碘酶抑制。
UNASSIGNED: Tyrosine-kinase inhibitors (TKIs) are chemotherapeutic agents associated with increased thyroid-hormone requirements and altered deiodinase activity. We present the first case to link these findings to the TKI ibrutinib.
UNASSIGNED: Serial thyroid-stimulating hormone (TSH), free-thyroxine (FT4), free-triiodothyronine (FT3), and reverse-triiodothyronine (rT3) levels were assessed.
UNASSIGNED: An 80-year-old, 62-kg woman with hypothyroidism secondary to total thyroidectomy for stage I papillary thyroid cancer, on maintenance levothyroxine (LT4) 137 μg daily, presented for follow-up. Compared to one year prior, the patient\'s weight had increased by 2 kg and TSH from 2.58 to 27.60 μIU/mL (normal: 0.45-4.50 μIU/mL) while on pantoprazole. Ibrutinib, her other medication, had been started seven months prior for chronic lymphocytic leukemia. Despite sequential confirmation of proper LT4 adherence and self-administration, adjustment of LT4 to 150 μg, and discontinuation of pantoprazole, the patient\'s hypothyroid symptoms worsened, and the TSH was 73.90 μIU/mL six months later. LT4 was increased to 175 μg six days a week and 262.5 μg once weekly. Two months later, the TSH was 3.92 μIU/mL (steady-state condition), FT4 2.32 ng/dL (normal: 0.82-1.77 ng/dL), FT3 1.6 pg/mL (normal: 2.0-4.4 pg/mL), and rT3 69.6 ng/dL (normal: 9.2-24.1 ng/dL). Ibrutinib was discontinued the next month due to gastrointestinal side effects and elevated blood pressure. Four months later, LT4 had been reduced to 150 μg, and the FT4 reached 1.92 ng/dL, FT3 2.0 pg/mL, and rT3 26.6 ng/dL.
UNASSIGNED: This report links ibrutinib to increased thyroid-hormone requirements in a thyroidectomized woman whose decreased T3:T4, T3:rT3, and T4:rT3 ratios suggested type 3 deiodinase induction and type 2 deiodinase inhibition.