Hashimoto Mariko, Nagayama Yoshikuni, Ichikura-Iida Ayana, Inoue Takashi
Nephrology, Yokohama Municipal Citizen's Hospital, Yokohama, JPN.
Cureus. 2024 Dec 28;16(12):e76499. doi: 10.7759/cureus.76499. eCollection 2024 Dec.
Hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) is a novel class of orally administered medications for renal anemia in patients with end-stage renal disease (ESRD). Roxadustat, a HIF-PHI, has a structure similar to that of triiodothyronine and may work as an agonist for thyroid hormone receptor-beta in the pituitary gland and/or hypothalamus. Therefore, roxadustat may cause central hypothyroidism due to suppressing thyroid-stimulating hormone (TSH) release in the pituitary gland and/or thyrotropin-releasing hormone release in the hypothalamus. On the other hand, some symptoms of uremia and hypothyroidism, such as fatigue, anorexia, or edema, are common. Therefore, hypothyroidism might be masked by uremia in patients with ESRD. We herein report the case of a 74-year-old man with roxadustat-induced central hypothyroidism masked by uremia at the initiation of hemodialysis. After stopping roxadustat medication without thyroid hormone replacement therapy, the patient's TSH, free triiodothyronine, and free tetraiodothyronine levels returned to the normal range rapidly, and uremic-like symptoms such as anorexia and physical fatigue also gradually recovered. The number of ESRD patients undergoing treatment for renal anemia with roxadustat might increase in the future; hence, close attention to roxadustat-induced central hypothyroidism in ESRD patients with uremia at the initiation of hemodialysis is essential.
缺氧诱导因子脯氨酰羟化酶抑制剂（HIF-PHI）是一类用于治疗终末期肾病（ESRD）患者肾性贫血的新型口服药物。罗沙司他作为一种HIF-PHI，其结构与三碘甲状腺原氨酸相似，可能作为垂体和/或下丘脑甲状腺激素受体-β的激动剂发挥作用。因此，罗沙司他可能通过抑制垂体促甲状腺激素（TSH）释放和/或下丘脑促甲状腺激素释放激素释放而导致中枢性甲状腺功能减退。另一方面，尿毒症和甲状腺功能减退的一些症状，如疲劳、厌食或水肿，较为常见。因此，ESRD患者的甲状腺功能减退可能被尿毒症掩盖。我们在此报告一例74岁男性患者，在开始血液透析时，其罗沙司他诱导的中枢性甲状腺功能减退被尿毒症掩盖。在停用罗沙司他药物且未进行甲状腺激素替代治疗后，患者的TSH、游离三碘甲状腺原氨酸和游离甲状腺素水平迅速恢复至正常范围，厌食和身体疲劳等尿毒症样症状也逐渐恢复。未来，接受罗沙司他治疗肾性贫血的ESRD患者数量可能会增加；因此，对于开始血液透析时合并尿毒症的ESRD患者，密切关注罗沙司他诱导的中枢性甲状腺功能减退至关重要。
