罗沙司他治疗透析患者肾性贫血时抑制促甲状腺激素分泌。
Suppression of thyrotropin secretion during roxadustat treatment for renal anemia in a patient undergoing hemodialysis.
机构信息
Division of Internal Medicine, Inoue Hospital, Suita, Japan.
Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, 545-8585, Osaka, Japan.
出版信息
BMC Nephrol. 2021 Mar 20;22(1):104. doi: 10.1186/s12882-021-02304-2.
BACKGROUND
Inhibition of hypoxia-inducible factor prolyl hydroxylase (HIF-PH) is a novel choice for the treatment of renal anemia, and an oral HIF-PH inhibitor roxadustat was approved for renal anemia. Roxadustat has high affinity to thyroid hormone receptor beta, which may affect thyroid hormone homeostasis.
CASE PRESENTATION
We present here a patient undergoing hemodialysis with primary hypothyroidism receiving levothyroxine replacement, who showed decreased free thyroxine (FT4) and thyroid stimulating hormone (TSH) after starting roxadustat. Pituitary stimulation test revealed selective suppression of TSH secretion. Recovery of TSH and FT4 levels after stopping roxadustat suggested the suppression of TSH was reversible.
CONCLUSIONS
Physicians should pay special attention to thyroid hormone abnormalities in treatment with roxadustat.
背景
抑制缺氧诱导因子脯氨酰羟化酶（HIF-PH）是治疗肾性贫血的一种新选择，一种口服 HIF-PH 抑制剂罗沙司他已被批准用于肾性贫血。罗沙司他对甲状腺激素受体 β 具有高亲和力，这可能会影响甲状腺激素的动态平衡。
病例介绍
我们在此介绍一位正在接受血液透析的原发性甲状腺功能减退症患者，该患者正在接受左甲状腺素替代治疗，在开始使用罗沙司他后，游离甲状腺素（FT4）和促甲状腺激素（TSH）水平降低。垂体刺激试验显示 TSH 分泌选择性抑制。停用罗沙司他后 TSH 和 FT4 水平恢复提示 TSH 抑制是可逆的。
结论
在使用罗沙司他治疗时，医生应特别注意甲状腺激素异常。
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