Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kitaku, Sapporo 060-8638, Japan.
Br J Cancer. 2011 Jan 18;104(2):241-7. doi: 10.1038/sj.bjc.6606029. Epub 2010 Dec 14.
To elucidate the incidence and mechanisms of sunitinib-induced thyroid atrophy, we investigated serial volumetric and functional changes, and evaluated histological changes of the thyroid gland in metastatic renal cell carcinoma patients who received sunitinib.
Thyroid volume (by computed tomography volumetry) and thyroid function were measured at baseline, during the treatment, and at post-treatment periods. Histological evaluation of the thyroid gland was performed in four autopsied patients.
The median reduction rate in thyroid volume at last evaluation during sunitinib treatment was 30% in all 17 patients. The incidence of hypothyroidism during sunitinib treatment was significantly higher in the high reduction rate group (n=8; more than 50% reduction in volume) than in the low reduction rate group (n=9; less than 50% reduction in volume). Half of the patients in the high reduction rate group exhibited a transient thyroid-stimulating hormone suppression, suggesting thyrotoxicosis during sunitinib treatment. Histological evaluation demonstrated atrophy of thyroid follicles and degeneration of follicular epithelial cells without critical diminution of vascular volume in the thyroid gland.
Thyroid atrophy is frequently observed following sunitinib treatment and may be brought about by sunitinib-induced thyrotoxicosis or the direct effects of sunitinib that lead to degeneration of thyroid follicular cells.
为了阐明舒尼替尼引起甲状腺萎缩的发生率和机制，我们研究了转移性肾细胞癌患者接受舒尼替尼治疗后甲状腺的容积和功能的连续变化，并评估了甲状腺的组织学变化。
在基线、治疗期间和治疗后期间，通过计算机断层扫描体积测量法测量甲状腺体积和甲状腺功能。对 4 例尸检患者的甲状腺进行组织学评估。
在 17 例患者的最后一次评估中，甲状腺体积的中位数在舒尼替尼治疗期间的减少率为 30%。在高减少率组（n=8；体积减少超过 50%）中，甲状腺功能减退的发生率明显高于低减少率组（n=9；体积减少小于 50%）。高减少率组中有一半的患者在舒尼替尼治疗期间出现短暂的促甲状腺激素抑制，提示甲状腺毒症。组织学评估显示甲状腺滤泡萎缩和滤泡上皮细胞变性，而甲状腺内血管容积没有明显减少。
舒尼替尼治疗后常观察到甲状腺萎缩，可能是由舒尼替尼诱导的甲状腺毒症或舒尼替尼的直接作用导致甲状腺滤泡细胞变性引起的。
