Review Article

Tyrosine Kinase Inhibitors Induced Thyroid Dysfunction: A Review of Its Incidence, Pathophysiology, Clinical Relevance, and Treatment

Table 2

Incidence and prevalence of tyrosine kinase inhibitor associated thyroid dysfunction.

Authors (year)Study typeTKI drug typeNumber of patientsTumor typePatients with hypothyroidism (↑TSH) (%)Patients with isolated suppressed TSH (%)Patients with suppressed TSH prior to elevated TSH (%)

Rini et al.
[15] (2007)
RetrospectiveSunitinib66RCC56 (85%)NoneNone

Wong et al.
[16] (2007)
RetrospectiveSunitinib40Solid (mostly GIST)21 (53%)NoneNone

Desai et al.
[14] (2006)
ProspectiveSunitinib42GISTPersistent = 15 (36%)
Transient = 7 (17%)
4 (10%)6 (14%)

Mannavola et al.
[17] (2007)
ProspectiveSunitinib24GISTTotal = 17 (71%)
Persistent = 11 (46%)
NoneNone

Wolter et al.
[18] (2008)
ProspectiveSunitinib59RCC, GISTTotal = 36 (61%)
16 (27%) required thyroid hormone treatment
20 (34%) did not require thyroid hormone treatment
NoneNone

Shinohara et al.
[19] (2011)
ProspectiveSunitinib17RCC8 (47%)NoneNone

Tamaskar et al.
[21] (2008)
RetrospectiveSorafenib39RCC7 (18%)1 (2.6%)None

Clement et al.
[22] (2008)
ProspectiveSorafenib38RCC7 (30%)1 (5%)None

Schmidinger et al.
[23] (2011)
ProspectiveSunitinib or sorafenib87RCC5 (5.7%) subclinical hypothyroidism in 30 patients (36.1%) after 2 months of treatment NoneNone

Riesenbeck et al.
[24] (2011)
Sunitinib or sorafenib66RCC21 (31.8%)NoneNone

de Groot et al.
[25] (2007)
ProspectiveImatinib11MTC, GIST8 out of 8 patients with previous thyroidectomies had increased thyroid hormone requirement Other patients were euthyroidNoneNone

de Groot et al.
[26] (2005)
ProspectiveImatinib15MTC9 out of 10 patients with previous thyroidectomies had increased thyroid hormone requirement Other patients were euthyroidNoneNone

Kim et al.
[27] (2010)
ProspectiveNilotinib55Ph-positive
CML
Total = 12 (22%)
Transient = 8 (15%)
Persistent = 4 (7%)
Total = 18 (33%)
Transient = 15 (27%)
Persistent = 3 (5%)
None

Sherman et al.
[35] (2008)
ProspectiveMotesanib diphosphate99DTC17 (22%) (all patients athyreotic)NoneNone

Robinson et al.
[36] (2010)
ProspectiveVandetanib19MTC Mean 5.1-fold increase in TSH in 17 patients with available TFTsNoneNone

Robinson et al.
[36] (2010)
ProspectiveAxitinib18Solid tumors16 (89%)NoneNone

Ohba et al.
[28] (2013)
ProspectiveAxitinib6Metastatic renal cell carcinoma5 (83%)1 (16%)4 (66.6%)

Fujiwara et al.
[29] (2012)
ProspectiveAxitinib18Advanced solid tumors16 (89%)NoneNone

Mukohara et al.
[30] (2010)
ProspectiveAxitinib12Advanced solid tumors11 (92%)NoneNone

Wolter et al.
[32] (2011)
ProspectivePazopanib578Renal cell carcinomaElevated TSH at baseline (>5 MU/L) was 37 (6%).
167 (29%) patients had a TSH value of >5 MU/L during treatment;
97 (17%) patients had TSH values of >5–10 MU/L during treatment;
45 (8%) patients had TSH values of >10–20 MU/L; and 25 (4%) patients had TSH values of >20 MU/L. Hypothyroidism (TSH > 5–10 MU/L, and T4 < LLN) was observed in 19 (3%) patients. Hypothyroidism with TSH > 10 MU/L and T4 < LLN was diagnosed in 15 (3%) patients
Hyperthyroidism, defined as TSH < 0.3 MU/L and T4 > ULN, was seen in 8 (1%) patientsNone

Sherman et al. [35] (2008)Prospective (phase III trial)Pazopanib202Locally advanced or metastatic renal cell carcinoma<10%NoneNone

Motzer [34] (2013)Prospective (phase III trial)Tivozanib260Advanced renal cell carcinomaPreliminary results: the incidence of hypothyroidism was higher in the tivozanib arm (13 subjects, 5.0%) than in the sorafenib arm (6 subjects, 2.3%)NoneNone