title: Auto-immune thyroid dysfunction induced by tyrosine kinase inhibitors in a patient with recurrent chordoma.
abstract: While hypothyroidism has frequently been reported with the use of TKIs, the thyroid-stimulating hormone (TSH) suppressing effect of TKIs is rare, except for thyroiditis. We describe a case with progressive recurrent chordoma who initially became hyperthyroid in a context of autoimmunity under sorafenib treatment and later under imatinib treatment.
  
  
  
  A 57-year-old man with lumbar chordoma began daily treatment of 800 mg sorafenib. He did not have any other medication or recent iodinated-contrast exposure and his family history was negative for thyroid and autoimmune disease. There was no history of neck pain, irradiation or trauma, recent fever or viral illness. Pre-treatment TSH was normal. After 18 weeks of treatment, the patient presented hyperthyroidism with positive anti-TSH receptor antibodies. More surprisingly, Graves' disease recurred during treatment with imatinib.
  
  
  
  The fact that Graves' disease occurred after two different TKIs suggests that it could be a rare but important class effect. Anti-TSH receptor antibodies should be systematically measured when TSH decreases in order to avoid the erroneous diagnosis of transient hyperthyroidism due to thyroiditis.
authors: Department of Medicine, Division of endocrinology, APHM, Conception Hospital, Marseille, France. Juliette.EROUKHMANOFF@ap-hm.fr.
authors: Juliette
authors: J
authors: Eroukhmanoff
authors: Department of Medicine, Division of endocrinology, APHM, Conception Hospital, Marseille, France.
authors: Frederic
authors: F
authors: Castinetti
authors: Department of Medicine, Division of adult oncology, Oscar Lambret Institute, Lille, France.
authors: Nicolas
authors: N
authors: Penel
authors: Aix Marseille Univ, INSERM, U911, Marseille, France.|Department of Medicine, Division of adult oncology, APHM, Timone Hospital, Marseille, France.
authors: Sebastien
authors: S
authors: Salas
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D002817:Chordoma / Q000188:drug therapy*; D006111:Graves Disease / Q000139:chemically induced*; D006801:Humans; D000068877:Imatinib Mesylate / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000068877:Imatinib Mesylate; D000077157:Sorafenib
keywords: Auto-immune thyroid dysfunction; Chordoma; Tyrosine kinase inhibitors