Hipotiroidismo induzido pelos inibidores da tirosina-cinase

Abstract

Thyroid dysfunction is an important adverse effect of tyrosine kinase inhibitors (TKI). To assess the prevalence of hypothyroidism in patients treated with TKI at our institution between 2003 and 2012, we reviewed their clinical records. One hundred and seven patients were evaluated, 56% male. Erlotinib was used in 27 patients, imatinib in 30, sunitinib in 17, lapatinib in 15, sorafenib in 7, gefitinib in 1 and more than one TKI in 10 patient (8 imatinib+sunitinib, 1 sunitinib+sorafenib, 1 imatinib+dasatinib). Of 107 patients, 59 (55%) performed thyroid function evaluation, in which hypothyroidism was documented in 35.6% (21 patients). Hypothyroidism was detected after a mean (±SD) time of 9.3±5.8 months of therapy. Levothyroxine was initiated in 11 patients. Hypothyroidism occurred in 57%, 46% e 17% of the patients treated with sunitinib, lapatinib and sorafenib, respectively. Seventy five percent of the patients treated with more than one TKI presented hypothyroidism and in all cases one of TKI was sunitinib. Of the patients receiving erlotinib, imatinib or gefitinib monotherapy that underwent thyroid function evaluation, none had hypothyroidism. The main limitation of the study is the low number of patients in each subgroup, however hypothyroidism seems to be more prevalent in patients on sunitinib or lapatinib. With the high prevalence of hypothyroidism in patients under TKI it is recommended to perform thyroid function assessment before and periodically during the treatment.