Butt MI, Khalid Bakhsh AM, Nadri QJ. Lenvatinib-induced multiorgan adverse events in Hurthle cell thyroid cancer: A case report. World J Clin Oncol 2021; 12(4): 272-281 [PMID: 33959480 DOI: 10.5306/wjco.v12.i4.272]
Corresponding Author of This Article
Muhammad Imran Butt, FRCP, MD, MRCP, Doctor, Department of Medicine, King Faisal Specialist Hospital, Research Centre, Al Faisal University, Zahrawi St, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia. mimran74@hotmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Apr 24, 2021; 12(4): 272-281 Published online Apr 24, 2021. doi: 10.5306/wjco.v12.i4.272
Lenvatinib-induced multiorgan adverse events in Hurthle cell thyroid cancer: A case report
Muhammad Imran Butt, Abdulmohsen Mohammed Khalid Bakhsh, Quaid Johar Nadri
Muhammad Imran Butt, Abdulmohsen Mohammed Khalid Bakhsh, Quaid Johar Nadri, Department of Medicine, King Faisal Specialist Hospital, Research Centre, Al Faisal University, Riyadh 12713, Saudi Arabia
Author contributions: Butt MI is the primary endocrinology physician involved in the care of the patient, and he reviewed the literature and drafted the manuscript; Bakhsh MK is the endocrinology fellow who took informed written consent from the patient and collated and prepared the laboratory data for the manuscript; Nadri QJ offered nephrology consultation and care for the management of renal adverse events; all authors reviewed and approved the final version of the manuscript.
Informed consent statement: The patient provided a written informed consent. We conducted the study in accordance with the guidelines outlined in the declaration of Helsinki. This study was approved by the Institutional Ethics Committee of King Faisal Specialist Hospital and Research Centre (approval No. RAC 2200330).
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammad Imran Butt, FRCP, MD, MRCP, Doctor, Department of Medicine, King Faisal Specialist Hospital, Research Centre, Al Faisal University, Zahrawi St, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia. mimran74@hotmail.com
Received: December 22, 2020 Peer-review started: December 22, 2020 First decision: January 11, 2021 Revised: January 30, 2021 Accepted: March 7, 2021 Article in press: March 7, 2021 Published online: April 24, 2021 Processing time: 119 Days and 4.9 Hours
Abstract
BACKGROUND
The management of metastatic progressive radioiodine-resistant differentiated thyroid cancer remains challenging for clinicians. The availability of tyrosine kinase inhibitors (TKIs), sorafenib and lenvatinib, within the last decade has expanded treatment options; however, these lead to significant adverse effects, which may curtail their use.
CASE SUMMARY
We report the case of a 47-year-old female with Hurthle cell thyroid cancer who underwent total thyroidectomy followed by radioiodine ablation. During follow-up, she developed noniodine-avid renal and pulmonary metastases. With respect to her pre-existing diabetes, hypertension, and polycystic kidney disease, the tumor board decided against performing renal metastasectomy because of the risk of future renal decline requiring dialysis. Metastases were treated using sorafenib, which provided stability followed by progression within a year. We switched to lenvatinib, which led to disease regression. However, the patient experienced severe adverse effects, including cardiomyopathy, bicytopenia, renal impairment, and the rarely reported nephrotic syndrome. Renal metastasis is a rare manifes-tation of Hurthle cell thyroid cancer with only two reported cases in literature. We report the experience of our first case of renal metastasis and its treatment with TKIs. This case serves as a reminder of the adverse drug reactions associated with TKI use.
CONCLUSION
We advocate close monitoring of patients’ hematological and renal profiles as well as their cardiac status using an echocardiogram.
Core Tip: The present case study provides a unique learning and case management experience. Our patient had widespread metastasis from a histopathologically low-risk thyroid cancer coupled with two decades of survival despite noniodine-avid metastasis, treatment of renal metastasis with tyrosine kinase inhibitors, and the development of multisystem adverse events, including rare nephrotic syndrome.
