Disfunción tiroidea en los pacientes con carcinoma de células renales avanzado en tratamiento con sunitinib: un problema multifactorial / Thyroid dysfunction in patients with advanced renal cell carcinoma treated with sunitinib: A multifactorial issue

Objetivo Distintos estudios ya han señalado la prevalencia importante de disfunción tiroidea inducida por sunitinib. No obstante, se desconoce el mecanismo de acción subyacente y el beneficio del tratamiento sustitutivo. Con el objeto de evaluar la función tiroidea en los pacientes con carcinoma de células renales avanzado tratados con sunitinib, se realizó el estudio descriptivo presentado. Material y métodos Se incluyeron 24 pacientes tratados entre 2006 y 2008 en el Hospital Clínico San Carlos. Los datos recogidos de forma retrospectiva se analizaron con el paquete estadístico SPSS 15.0.ResultadosLa duración del tratamiento fue de 30 (18–42) semanas (mediana [RIQ]). Cinco pacientes (20,8%) desarrollaron hipotiroidismo subclínico, y 3 (12,5%) hipotiroidismo clínico. El número de semanas necesarias para observar elevación de TSH fue 15 (6–20) (mediana [RIQ]). Cinco pacientes (20,8%) presentaron TSH disminuida previa al tratamiento o durante el mismo, sin poder establecer el diagnóstico de hipertiroidismo subclínico dados los factores intercurrentes. Catorce pacientes (58,3%) presentaron toxicidad, sin encontrarse una asociación con el desarrollo de hipotiroidismo (p=0,388).Conclusiones La elevada prevalencia de hipotiroidismo inducido por sunitinib hace necesario un seguimiento sistemático de la función tiroidea en estos pacientes. No obstante, dicho estudio puede estar interferido por distintos factores fisiopatológicos y farmacológicos, por lo que podría ser útil determinar no solo TSH y T4 libre, sino también T3 libre e, idealmente, T3 reversa. A día de hoy carecemos de recomendaciones para el manejo del hipotiroidismo en el paciente oncológico basadas en la evidencia (AU)

Objective Several studies have reported the substantial prevalence of sunitinib-induced thyroid dysfunction. However, the underlying mechanism and the benefit of thyroid hormone replacement therapy remain to be determined. To evaluate the effect of sunitinib on thyroid function, we carried out a descriptive study in patients with advanced renal cell carcinoma. Patients and methods A total of 24 patients treated by sunitinib between 2006 and 2008 at Hospital Clínico San Carlos were included. The data were collected retrospectively and analyzed with SPSS 15.0.ResultsTreatment duration was 30 weeks (18–42) [median (IQR)]. Five patients (20.8%) developed subclinical hypothyroidism and three (12.5%) developed overt hypothyroidism. The number of weeks needed to observe an increase in thyroid-stimulating hormone (TSH) values in these patients was 15 (6–20) [median (IQR)]. TSH levels were below the normal range in five patients (20.8%) before or during the treatment period, but the diagnosis of subclinical hyperthyroidism could not be established because of concomitant factors. Fourteen patients (58.3%) showed sunitinib adverse events, but these were not related to the development of hypothyroidism (p=0.388).Conclusions Because of the high prevalence of sunitinib-induced hypothyroidism, thyroid function should be systematically monitored in patients with renal cell carcinoma treated with this drug. However, several pathophysiological and pharmacological factors may interfere with monitoring. Consequently, it might be useful to determine not only TSH and free T4 but also free T3 and, ideally, reverse T3. Evidence-based recommendations to manage hypothyroidism in oncology patients are not available at present (AU)

[Thyroid dysfunction in patients with advanced renal cell carcinoma treated with sunitinib: a multifactorial issue]. / Disfunción tiroidea en los pacientes con carcinoma de células renales avanzado en tratamiento con sunitinib: un problema multifactorial.

OBJECTIVE: Several studies have reported the substantial prevalence of sunitinib-induced thyroid dysfunction. However, the underlying mechanism and the benefit of thyroid hormone replacement therapy remain to be determined. To evaluate the effect of sunitinib on thyroid function, we carried out a descriptive study in patients with advanced renal cell carcinoma. PATIENTS AND METHODS: A total of 24 patients treated by sunitinib between 2006 and 2008 at Hospital Clínico San Carlos were included. The data were collected retrospectively and analyzed with SPSS 15.0. RESULTS: Treatment duration was 30 weeks (18-42) [median (IQR)]. Five patients (20.8%) developed subclinical hypothyroidism and three (12.5%) developed overt hypothyroidism. The number of weeks needed to observe an increase in thyroid-stimulating hormone (TSH) values in these patients was 15 (6-20) [median (IQR)]. TSH levels were below the normal range in five patients (20.8%) before or during the treatment period, but the diagnosis of subclinical hyperthyroidism could not be established because of concomitant factors. Fourteen patients (58.3%) showed sunitinib adverse events, but these were not related to the development of hypothyroidism (p=0.388). CONCLUSIONS: Because of the high prevalence of sunitinib-induced hypothyroidism, thyroid function should be systematically monitored in patients with renal cell carcinoma treated with this drug. However, several pathophysiological and pharmacological factors may interfere with monitoring. Consequently, it might be useful to determine not only TSH and free T4 but also free T3 and, ideally, reverse T3. Evidence-based recommendations to manage hypothyroidism in oncology patients are not available at present.