Int J Thyroidol.  2018 Nov;11(2):78-81. 10.11106/ijt.2018.11.2.78.

Management of Hypertension and Proteinuria after Treatment with Lenvatinib for Radioiodine Refractory Papillary Thyroid Carcinoma: a Case Report

• Song E
• Kim WG

• KMID: 2448975
• DOI: http://doi.org/10.11106/ijt.2018.11.2.78

Abstract

Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

Keyword

Papillary thyroid carcinoma; Lenvatinib; Proteinuria; Hypertension

MeSH Terms

Aged
Blood Vessels
Humans
Hypertension*
Iodine
Lymph Nodes
Neoplasm Metastasis
Proteinuria*
Thyroid Gland*
Thyroid Neoplasms*
Iodine

Figure

• 

  Fig. 1 The radiologic findings of the recurrent tumor in posterior wall of upper thoracic trachea and metastatic cervical lymph nodes. (A, B) Baseline images before initiation of lenvatinib. (C, D) Images of eight months after show decreased extent of the lesions. Arrows pointing for the tracheal lesion (A, C) and cervical lymph node (B, D).

• 

  Fig. 2 Description of the patient's course. P/C: protein/creatinine, GFR: glomerular filtration rate

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