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Bexarotene central hypothyroidism tests – Bexarotene: A Rare Cause of Misleading Thyroid Function Tests

Bexarotene increases uptake of radioiodide in metastases of differentiated thyroid carcinoma.

William Murphy
Saturday, July 9, 2016
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  • Case Report Volume 4, Number 4, Augustpages Baris Sariakcali was the treating physician of the patient.

  • Eur J Endocrinol : —

  • The patient continued follow-up visits with 3 months intervals. LT4 replacement is easily titrated in patients with primary hypothyroidism by measurement of serum TSH levels.

  • It appears likely that glucuronidation of T 4 is also increased by bexarotene, but this could not be investigated in our patients.

Patients and Methods

Minimally, it should be considered for patients with a pretreatment TSH above 1. TABLE 1. J Immunoassay 9 : —

In addition to these observations, experimental studies have also suggested that rexinoids may influence peripheral thyroid hormone metabolism bexarotene central hypothyroidism tests increased 5 or decreased 8 type 1 deiodinase activity or by the induction of hepatic detoxification enzymes, which may constitute a nondeiodinase mechanism of thyroid hormone metabolism 9. Publication types Review. Google Scholar. Skip Nav Destination Article Navigation.

Mol Cell Endocrinol : — Therapy with bexarotene is accompanied by central hypothyroidism 4. Vishnu Sundaresh has received payment from a patient education research grant from Radius Health Inc; however, it is not related to this manuscript and presents no conflict of interest with the presented case report. Reversible diastolic dysfunction after long-term exogenous subclinical hyperthyroidism: a randomized, placebo-controlled study. Substances Thyrotropin Bexarotene Thyroxine.

Patients and Methods

In this review, the authors summarize the recent knowledge on the genetic causes of congenital central hypothyroidism when combined with multiple pituitary hormone deficiencies. In a study in human volunteers, a single dose of bexarotene decreased serum TSH, T 4and T 3 levels 7. Bexarotene is a synthetic retinoid X receptor RXR -selective retinoid recently approved for treatment of cutaneous T-cell lymphoma. We report a patient with Sezary syndrome cutaneous T-cell lymphoma who developed severe central hypothyroidism and mixed hyperlipidemia due to the bexarotene treatment a synthetic retinoid analog with specific affinity for retinoid X receptor used in the treatment of Sezary syndrome. Select Format Select format.

Issue Section:. Hypothyroidism tests bedarotene alert. Two patients had well-controlled hypertension, one patient had well-controlled ischemic heart disease, and one patient had obstructive pulmonary disease. Smit, Marcel P. Keywords: bexarotene; central hypothyroidism; cutaneous t-cell lymphoma; mycosis fungoides. Short-term running exercise alters DNA methylation patterns in neuronal nitric oxide synthase and brain-derived neurotrophic factor genes in the mouse hippocampus and reduces anxiety-like behaviors.

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  • In other studies, the retinoids all-trans retinoic acid and 9-cis retinoic were found to stimulate D3 activity in different cell types but decreased D3 activity in neuroblastoma cells 16 No differences were observed in serum glucose levels 5.

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Citing articles via Web of Science Central hypothyroidism associated with retinoid Tests receptor-selective ligands. Are you sure the patient has Central Hypothyroidism? CH may present as an isolated finding or may be associated with other pituitary hormone deficiencies. We report a patient with Sezary syndrome cutaneous T-cell lymphoma who developed severe central hypothyroidism and mixed hyperlipidemia due to the bexarotene treatment a synthetic retinoid analog with specific affinity for retinoid X receptor used in the treatment of Sezary syndrome. Google Scholar. Multinodular goiter and solitary nodule.

We report a case tests an year-old Caucasian male with cutaneous Beaxrotene lymphoma CTCL who was treated with bexarotene. Bexarotene increases uptake of radioiodide in metastases of differentiated thyroid carcinoma. Exclusion criteria were pregnancy, contraindications for the application of recombinant human TSH rhTSHand contraindications for the use of bexarotene. We assessed T 4 S as an indicator for the sulfation pathway. J Clin Endocrinol Metab 92 : —

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Indeed, the net effects of bexarotene on peripheral metabolism of thyroid hormones can only be studied in athyreotic subjects. Although central hypothyroidism through decreased TSH synthesis by bexarotene testw been well established in experimental studies 561314 and in humans 47these studies could not exclude that altered peripheral metabolism of thyroid hormone could also contribute to bexarotene-induced hypothyroidism. Vishnu Sundaresh has received payment from a patient education research grant from Radius Health Inc; however, it is not related to this manuscript and presents no conflict of interest with the presented case report.

  • These are rare adverse effects of bexarotene treatment and there are a few case reports in literature.

  • Serum thyroid hormone-binding globulin levels remained unaltered.

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Register for free and gain unlimited access to:. These observations suggest that bexarotene probably has two fundamental effects on thyroid function: to suppress TSH production and to increase thyroid hormone metabolic clearance. Search Menu. Open in new tab.

Before bexarotene and in the last week of bexarotene therapy, the patients received two injections of 0. T 4 S decreased after treatment with bexarotene. The bexarotene central hypothyroidism tests explanation, that bexarotene had interfered with the intestinal absorption of l -T 4 is unlikely, because the interval between bexarotene and l -T 4 intake was approximately 12 h but cannot entirely ruled out. Anti-microsomal and anti-thyroglobulin antibodies were found to be not increased. In this paper, the authors underline the fact that undoubtedly FT4 measurement is the best indicator of central hypothyroidism, but remains in the low normal range in a significant subset of patients.

This case represents an example of missed CH due to bexarotene, -which led to suboptimal LT4 replacement impacting the quality of life for the patient. Eur J Endocrinol. We could maintain bexarotene therapy in this patient with euthyroid state and normal lipid levels. Pereira, Johannes A. Enjoying our content?

This ratio is also relatively independent of thyroidal Bexarotene central hypothyroidism tests 4 production and of variations in serum binding proteins. T 4 sulfate T 4 S was measured as a marker for T 4 degradation. Article Contents Abstract. Eventually, total triiodothyronine T 3 dropped to a low level of 0. LaFranchi, SH.

No human studies have been published to address the effects of bexarotene on peripheral thyroid hormone metabolism. Theo J. P value a. Drug Metab Dispos 26 : —

In this review, the authors summarize the recent knowledge on the genetic causes of congenital central hypothyroidism when combined with multiple pituitary hormone deficiencies. Romijn, Theo J. This study has been published previously 2. In this paper, the authors underline the fact that undoubtedly FT4 measurement is the best indicator of central hypothyroidism, but remains in the low normal range in a significant subset of patients. Cardiovascular outcomes in thyroid cancer patients treated with thyroidectomy: A meta-analysis. Thyroid hormone-related parameters.

Serum thyroid hormone-binding globulin levels remained unaltered. Retinoid bexarotene central hypothyroidism tests belong to the family hypothyroidjsm nuclear receptors and can be distinguished in retinoic acid receptors and retinoid X receptors. Bexarotene is also investigated for other malignancies, including thyroid carcinoma 2. Age yr. To evaluate the effects of bexarotene on peripheral thyroid hormone metabolism, we performed a study in athyreotic subjects on a fixed substitution dose with l -T 4.

Google Scholar. It furthers bexarotene central hypothyroidism tests University's objective of excellence in research, scholarship, and education by publishing worldwide. Bexarotene rapidly and reversibly suppresses serum TSH. Bexarotenr patients were included in the protocol. Therefore, the most likely explanation is increased degradation by other pathways than deiodination, such as hepatic conjugation mediated by UDP-glucuronyltransferases 18 and sulfotransferases This ratio is also relatively independent of thyroidal T 4 production and of variations in serum binding proteins. Email alerts Article activity alert.

  • J Immunoassay 9 : —

  • Pereira, Johannes A.

  • Volume Concomitant medication.

  • Bexarotene dose was increased, but LT4 was not increased by the primary physician who relied on TSH level, which was low, and hence the existing LT4 dose was maintained. Conclusions: Preventive treatment with levothyroxine is recommended for Japanese CTCL patients prior to bexarotene therapy.

In conclusion, in the present study, we demonstrated that increased peripheral degradation of thyroid hormones in addition tests decreased TSH secretion contributes to bexarotene-induced hypothyroidism. Cite Cite Johannes W. In addition, bexarotene also has effects on metabolic pathways such as insulin sensitivity 3. Two patients had well-controlled type 2 diabetes mellitus. J Clin Endocrinol Metab 90 : — SmitJohannes W.

This ratio is also relatively independent of thyroidal T 4 production and of variations in serum binding proteins. Publication types Case Reports. J Clin Endocrinol Metab 69 : — Smit, Marcel P.

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Other diagnoses. From another patient, baseline blood samples were missing, so 10 patients were included in the analysis. Johannes A.

The symptoms of hypothyroidism improved after normalizing hypothyroidism tests 4with an increase in the LT4 dose. Oxford University Press is a department of the University of Oxford. Forty-five study cases showed this effect at 1 week. Exclusion criteria were pregnancy, contraindications for the application of recombinant human TSH rhTSHand contraindications for the use of bexarotene.

Although mutations in the gene encoding TSH beta subunit are rare, this publication suggests a series of clinical and hyppthyroidism characteristics to reach a precise diagnosis. Login Register. This is an updated review on LT4 replacement therapy in patients with congenital primary or central hypothyroidism. In conclusion, LT4 replacement therapy should be carried out in patients with CH with the following considerations:. Close more info about Central hypothyroidism.

Eventually, total triiodothyronine T 3 dropped to a low level of 0. Receive exclusive offers and updates from Oxford Academic. TBG, Thyroid hormone binding globulin. Before bexarotene and in the last week of bexarotene therapy, the patients received two injections of 0.

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Patients visited the hospital every week for a physical examination and assessment of laboratory parameters. His pre-treatment TSH was normal at 1. Patient no.

Concomitant medication. Because the T 4 dose was kept stable during the study, increased metabolism of thyroid hormones is the most likely explanation. We started T4 replacement therapy and in about 3 months of the therapy, clinical findings improved and serum T3 and T4 levels increased to normal levels. In clinical trials, bexarotene was found to cause severe central hypothyroidism with high frequency, associated with marked reductions in serum concentrations of thyroid-stimulating hormone TSH and thyroxine. Google Scholar Crossref.

Select Format Select format. Male rat hepatic UDP-glucuronosyltransferase activity bexarotene central hypothyroidism tests thyroxine. Hypothyroidissm, the most likely explanation is increased degradation by other pathways than deiodination, such as hepatic conjugation mediated by UDP-glucuronyltransferases 18 and sulfotransferases Email alerts Article activity alert. T 4 sulfate T 4 S was measured as a marker for T 4 degradation. Google Scholar.

We assessed T 4 S as an indicator for the sulfation pathway. Thyroid hormones. Romijn, Theo J. Johannes A. Patients and Methods. Google Scholar PubMed.

Metabolism of thyroid hormones is mediated by iodothyronine deiodinases D1, D2, and D3 15 and by hepatic conjugating enzymes 9. View Metrics. Serum thyroid hormone-binding globulin levels remained unaltered. Their clinical characteristics are presented in Table 1. Eur J Endocrinol : —

  • J Clin Endocrinol Metab.

  • Pereira, Johannes A.

  • No human studies have been published to address the effects of bexarotene on peripheral thyroid hormone metabolism. The study results with respect to radioiodine uptake have been published previously 2.

  • Age yr.

Volume 4, Number 4, Bexarotene central hypothyroidism testspages bexsrotene The alternative explanation, that bexarotene had interfered with the intestinal absorption of l -T 4 is unlikely, because the interval between bexarotene and l -T 4 intake was approximately 12 h but cannot entirely ruled out. J Clin Endocrinol Metab 69 : — Patients and Methods.

View Metrics. The standard practice of monitoring thyroid function using thyroid-stimulating hormone TSH to adjust levothyroxine LT4 dose does not apply to bexarotene since it causes CH. Close more info about Central hypothyroidism. Histology, pTNM.

In iodine-deficient countries, consider the possible presence of a nodular goiter with autonomous thyroid hormone secretion in hyopthyroidism to prevent possible LT4 overtreatment. In patients who develop hypothyroidism during bexarotene therapy, it should be realized that TSH measurements are unreliable to monitor l -T 4 substitution therapy and that higher l -T 4 dosages may be required than expected because of the enhanced degradation of thyroid hormones. Abstract Bexarotene is a very rare cause of central hypothyroidism CH and its effects have been reported to be dose-dependent; however, the available data in the literature on dose-dependent effects are variable.

T 4 S was prepared by the method of Eelkman Rooda et al. Conclusions: In the present study, we demonstrate that increased peripheral degradation of thyroid hormones by a nondeiodinase-mediated pathway contributes to bexarotene induced-hypothyroidism. The evaluation of clinical and other biochemical indices of peripheral thyroid hormone action also have a limited role in monitoring LT4 treatment in CH patients. However, this method is not useful in patients with CH, although unsuppressed serum TSH levels during LT4 treatment strongly suggest undertreatment. J Clin Endocrinol Metab 90 : —

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A significant increase in hpyothyroidism levels of total cholesterol 5. Two patients had well-controlled hypertension, one patient had well-controlled hypothyroidism tests heart disease, and one patient had obstructive pulmonary disease. Serum T 4 S was measured using a specific antibody, as described previously Publication types Case Reports. Cardiovascular outcomes in thyroid cancer patients treated with thyroidectomy: A meta-analysis.

Advance article alerts. Thyroid hormone-related centtal. Therefore, the most likely explanation is increased degradation by other pathways than deiodination, such as hepatic conjugation mediated by UDP-glucuronyltransferases 18 and sulfotransferases Exclusion criteria were pregnancy, contraindications for the application of recombinant human TSH rhTSHand contraindications for the use of bexarotene.

SmitJohannes W. Theo J. Volume The present investigation was conducted to study the contribution of altered peripheral metabolism of thyroid hormones to bexarotene-induced hypothyroidism.

Google Scholar. The other pituitary functions were found to be normal. Twelve patients were included in the protocol. Effects of rexinoids bexarotene central hypothyroidism tests deiodinases have been described in experimental studies: Machia et al. In addition to these observations, rexinoids may influence peripheral thyroid hormone metabolism through increased or decreased type 1 deiodinase activity or by the induction of hepatic detoxification enzymes [ 15 ].

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Issue Section:. Thyroid hormone-related parameters are given hypothyroldism Table 2. Cite Cite Johannes W. View Metrics. Conclusions: Preventive treatment with levothyroxine is recommended for Japanese CTCL patients prior to bexarotene therapy. In conclusion, in the present study, we demonstrated that increased peripheral degradation of thyroid hormones in addition to decreased TSH secretion contributes to bexarotene-induced hypothyroidism.

Abstract Bexarotene is a very rare cause of central hypothyroidism CH and its bexaroteen have been reported to be bexarotene central hypothyroidism however, the available data in the literature on dose-dependent effects are variable. A year-old male was diagnosed with mycosis fungoides by skin biopsy in March 3, T 4 S was prepared by the method of Eelkman Rooda et al. On laboratory examination, anterior pituitary hormones were completely normal except thyroid-stimulating hormone TSH level. TBG, Thyroid hormone binding globulin. The patients tolerated the bexarotene treatment well. The etiology of sporadic CH is quite heterogeneous, and the following differential diagnoses should be considered:.

T 4 S decreased after treatment with bexarotene. This research project was supported by a grant from the Dutch Cancer Foundation. The study results with respect to radioiodine uptake have been published previously 2. Design: The design was an open prospective 6-wk intervention study.

Patient no. Identification of thyroxine-sulfate T4S in human serum and amniotic fluid by a novel T4S radioimmunoassay. TBG, Thyroid hormone binding globulin. J Clin Endocrinol Metab.

Semin Oncol 33 : S7 — S Two patients had well-controlled hypertension, one patient had well-controlled ischemic heart bexarotene central hypothyroidism tests, and one patient had obstructive pulmonary disease. The detection limit of the TSH assay was 0. A significant increase in serum levels of total cholesterol 5. Recombinant human TSH was administered before and in the sixth week of bexarotene therapy. Publication types Case Reports. N Engl J Med : —

Semin Oncol 33 : S7 — S Email bexarotene central hypothyroidism tests Article activity alert. All patients were in a good centrla condition eight patients had Karnofsky score 0; two patients had score 1. Patient no. The standard practice of monitoring thyroid function using thyroid-stimulating hormone TSH to adjust levothyroxine LT4 dose does not apply to bexarotene since it causes CH.

Some for overweight with CH with a predominantly hypothalamic defect may have high serum TSH levels, a potentially misleading diagnosis which may be confused with subclinical primary hypothyroidism. Concomitant medication. Levothyroxine doses were generally under-replaced in pituitary patients compared to primary thyroid disease and the data imply that some untreated patients were actually TSH deficient. A useful review of all the drugs that can interfere with the central regulation of thyroid function.

Treatment of patients with bexarotene-induced hypothyroidism commonly requires high doses of thyroid hormone for replacement therapy, often twice the typical doses used to treat more common etiologies of hypothyroidism. A study in apolipoprotein APO E2 bexarotene central hypothyroidism tests mice showed that bexarotene increased the expression of hepatic genes involved in triglyceride TG synthesis and very low-density lipoprotein VLDL production. Volume Bexarotene is a retinoid X receptor-selective retinoid a rexinoidwhich is approved in the US for the treatment of cutaneous manifestations of cutaneous T-cell lymphoma CTCL in patients refractory to at least one prior systemic therapy and in Europe for the treatment of patients with skin manifestations of advanced-stage CTCL refractory to at least one systemic therapy [ 12 ].

Thyroid 2 : — However, this method is not useful in patients with CH, although unsuppressed serum TSH levels during LT4 treatment strongly suggest undertreatment. Histology, pTNM. Johannes A.

This ratio is also ceentral independent of thyroidal T 4 production and of variations in serum binding proteins. Levothyroxine doses were generally under-replaced in pituitary patients compared to primary thyroid disease and the data imply that some untreated patients were actually TSH deficient. For example, recombinant human growth hormone treatment interferes with the activity of the hypothalamic-pituitary-thyroid axis and may either unmask a state of central hypothyroidism or render LT4 replacement therapy insufficient. Central hypothyroidism associated with retinoid X receptor-selective ligands. Recommendations are provided for diagnosis and treatment of this syndrome. Login Register.

Related articles in Web of Science Google Scholar. Design: The design was an open prospective 6-wk intervention study. Glia 11 : — Dynamic testing should be considered. Yamada, M, Mori, M.

  • J Endocrinol 73 : — LaFranchi, SH.

  • It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. J Endocrinol 73 : —

  • Case Report Volume 4, Number 4, Augustpages However, several recent papers regarding replacement LT4 therapy in patients with CH have outlined some of the problems in achieving optimal replacement.

  • Oxford Academic. Mechanism of selective retinoid X receptor agonist-induced hypothyroidism in the rat.

  • This research project was supported by a grant from the Dutch Cancer Foundation.

In addition to these observations, rexinoids may influence peripheral thyroid hormone metabolism through increased or decreased type 1 deiodinase activity or by the induction of hepatic detoxification enzymes [ 15 ]. Metabolism of thyroid hormones is mediated by iodothyronine deiodinases D1, D2, and D3 15 and by hepatic conjugating enzymes 9. His symptoms improved. Cite Cite Johannes W. One patient underwent acute surgery for intestinal volvulus. Email alerts Article activity alert.

In addition, treatment strategies are different between hypothyrodiism with CH that is diagnosed during the neonatal period than during early childhood. Receive exclusive offers and updates from Oxford Academic. Levothyroxine doses were generally under-replaced in pituitary patients compared to primary thyroid disease and the data imply that some untreated patients were actually TSH deficient. Johannes A.

Although central hypothyroidism through decreased TSH synthesis by bexarotene has been well established hypothyroidism tests experimental studies 561314 and in humans 4 hypothhyroidism, 7these studies could not exclude that altered peripheral metabolism of thyroid hormone could also contribute to bexarotene-induced hypothyroidism. J Clin Endocrinol Metab 90 : — In iodine-deficient countries, consider the possible presence of a nodular goiter with autonomous thyroid hormone secretion in order to prevent possible LT4 overtreatment. The calculations were performed using SPSS TABLE 1. Smit, Marcel P.

CH may present as an isolated finding or may be associated with other pituitary hormone deficiencies. On laboratory examination, anterior pituitary hormones were completely normal except thyroid-stimulating hormone TSH level. In clinical trials, bexarotene was found to cause severe central hypothyroidism with high frequency, associated with marked reductions in serum concentrations of thyroid-stimulating hormone TSH and thyroxine. In addition to these observations, rexinoids may influence peripheral thyroid hormone metabolism through increased or decreased type 1 deiodinase activity or by the induction of hepatic detoxification enzymes [ 15 ].

From another patient, baseline blood samples were missing, so 10 patients were included in the analysis. TBG, Thyroid hormone binding globulin. Hypoxia-inducible factors individually facilitate inflammatory myeloid metabolism and inefficient cardiac repair. SmitJohannes W.

We therefore studied the effects of bexarotene, administered for 6 wk, on peripheral thyroid hormone metabolism in athyreotic humans with stable thyroid hormone substitution. Conclusions: In the bexarotene central hypothyroidism study, we demonstrate that increased peripheral degradation of thyroid hormones by a nondeiodinase-mediated pathway contributes to bexarotene induced-hypothyroidism. While concomitant levothyroxine therapy is recommended in these cases, associations between ethnic variation or susceptibility and bexarotene-induced CH have not yet been reported. Mol Endocrinol 11 : — Other diagnoses. Metabolism of thyroid hormones is mediated by iodothyronine deiodinases D1, D2, and D3 15 and by hepatic conjugating enzymes 9. Substances Thyrotropin Bexarotene Thyroxine.

Marcel P. Cite Cite Johannes W. Concomitant medication. Semin Oncol 33 : S7 — S

Two patients had well-controlled bexarotene central hypothyroidism tests, one patient had well-controlled ischemic heart disease, and one patient had obstructive pulmonary disease. Indeed, the net effects of bexarotene on peripheral metabolism of thyroid hormones can only be studied in athyreotic subjects. The authors suggest to maintain the levels of circulating FT4 in the middle of the laboratory reference values.

The mechanism by which bexarotene can cause central hypothyroidism is not completely understood hypothyroidism tests is postulated to be secondary to direct suppression of TSH subunit teests, TSH secretion, and TSH clearance [ 4 ]. If adrenal function cannot be assessed prior to the start of LT4, prophylactic treatment with steroids is advised. Treatment of patients with bexarotene-induced hypothyroidism commonly requires high doses of thyroid hormone for replacement therapy, often twice the typical doses used to treat more common etiologies of hypothyroidism. Alberto M. Registration is free.

No differences were observed in serum glucose levels 5. The symptoms of hypothyroidism improved after normalizing fT 4with an increase in the LT4 dose. Indeed, the net effects of bexarotene on peripheral metabolism of thyroid hormones can only be studied in athyreotic subjects. Keywords: bexarotene; central hypothyroidism; cutaneous t-cell lymphoma; mycosis fungoides. From another patient, baseline blood samples were missing, so 10 patients were included in the analysis. Conclusions: Preventive treatment with levothyroxine is recommended for Japanese CTCL patients prior to bexarotene therapy.

Romijn, Theo J. High-density lipoprotein cholesterol was unaffected 1. In other studies, the retinoids all-trans retinoic acid and 9-cis retinoic were found to stimulate D3 activity in different cell types but decreased D3 activity in neuroblastoma cells 16 J Immunoassay 9 : — Hypoxia-inducible factors individually facilitate inflammatory myeloid metabolism and inefficient cardiac repair.

Citing articles via Web of Science Theo J. Open in new tab. J Clin Endocrinol Metab 69 : — Search Menu.

Related articles in Web of Science Google Scholar. Eventually, total triiodothyronine T 3 dropped to a low level of 0. Table 1. Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases.

Keywords: bexarotene; central hypothyroidism; cutaneous t-cell lymphoma; mycosis fungoides. Bexarotene treatment is associated with unavoidable side effects, in particular hypertriglyceridemia with hypercholesterolemia hypothyroidism tests central hypothyroidism, which are manageable with adequate concomitant medications and bexafotene reversible on cessation of treatment [ 12 ]. For example, recombinant human growth hormone treatment interferes with the activity of the hypothalamic-pituitary-thyroid axis and may either unmask a state of central hypothyroidism or render LT4 replacement therapy insufficient. Patient data. Inheritable forms of CH are generally associated with severe neonatal onset and characterized by typical manifestations of congenital primary hypothyroidism jaundice, macroglossia, coarse cry, failure to thrive, retarded growth, umbilical hernia, and hypotonia.

Hylothyroidism receptors belong to the family of nuclear receptors and can be distinguished in retinoic acid receptors and retinoid X receptors. P value a. Before bexarotene and in the last week of bexarotene therapy, the patients received two injections of 0. Hence, those patients who are treated with this agent must be followed for these serious adverse effects. Three patients had a history of hypercholesterolemia, which was treated with cholesterol synthesis inhibitors. In conclusion, bexarotene treatment may induce central hypothyroidism and hyperlipidemia.

T 4 sulfate T 4 S was measured as a marker for T 4 degradation. Thanks for visiting Endocrinology Advisor. It is recommended as a second-line therapy for the treatment of mycosis fungoides hypotjyroidism Sezary syndrome in a number of national and international guidelines [ 23 ]. Patients and Methods. In this review, the authors summarize the recent knowledge on the genetic causes of congenital central hypothyroidism when combined with multiple pituitary hormone deficiencies. Issue Section:. They conclude that GH deficiency may mask central hypothyroidism and that patients with FT4 values in the lower limit of the normal range should be treated with LT4 prior to commencement of GH replacement.

  • Eur J Endocrinol.

  • The patient had persistent symptoms of hypothyroidism and, eventually, a diagnosis of CH was made. Effects of rexinoids on thyrotrope function and the hypothalamic-pituitary-thyroid axis.

  • Because the T 4 dose was kept stable during the study, increased metabolism of thyroid hormones is the most likely explanation.

  • New issue alert.

Advance article alerts. We had to treat the patients hypothyroidism tests niascore and atorvastatin as well as T4 replacement. Teste 4 S decreased after treatment with bexarotene. Inheritable forms of CH are generally associated with severe neonatal onset and characterized by typical manifestations of congenital primary hypothyroidism jaundice, macroglossia, coarse cry, failure to thrive, retarded growth, umbilical hernia, and hypotonia.

This case represents an example of missed CH due centfal bexarotene, -which led to suboptimal LT4 replacement impacting the quality of life for the patient. Johannes W. These are rare adverse effects of bexarotene treatment and there are a few case reports in literature. Article Contents Abstract. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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