Dasatinib
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Dasatinib Subacute thyroiditis and hypothyroidism : case report
A 44-year-old man developed subacute thyroiditis and hypothyroidism during treatment with dasatinib for chronic myeloid leukaemia. The man consulted for pharyngeal discomfort and dysphagia for solids along with anterior cervical pain, fever, palpitations and weight loss of about 5kg. He had chronic myeloid leukaemia for which he had been receiving dasatinib 100mg daily [route not stated]. Suspecting the possibility of infection, he was treated with several cycles of antibiotics including amoxicillin/clavulanic acid. However, laboratory tests ruled out infection, and thus amoxicillin/clavulanic acid was stopped. Upon examination, a painful thyroid gland with increased size was noted, blood tests showed elevated levels of ESR, FT4 and c-reactive protein with anti-peroxidase. The anti-thyroglobulin antibodies were negative and TSH levels were supressed. A cervical ultrasound revealed a diffuse increase in the thyroid gland with decreased vascularisation and presence of a region in the right thyroid lobe suggestive of thyroiditis, without any abscesses or adenopathies. A thyroid scintigraphy scan demonstrated no glandular uptake. The man was hospitalised with a diagnosis of subacute thyroiditis and treated with propranolol and ibuprofen [time to reaction onsets not stated]. Following haematological assessment, dasatinib was stopped. Out-patiently, he continued to receive ibuprofen and propranolol. His condition improved and after 1 month, FT4 level normalised, but TSH remained slightly low. Due to hypothyroidism (sub-clinical hypothyroid profile), he was prescribed hormone replacement therapy at increasing doses and for underlying leukaemia, he was commenced on nilotinib. Vazquez Friol MDC, et al. Subacute thyroiditis by dasatinib. Medicina Clinica 155: 270-271, No. 6, 25 Sep 2020. Available from: URL: http://doi.org/10.1016/ j.medcli.2019.05.011 [Spanish; summarised from a translation]
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Reactions 10 Oct 2020 No. 1825
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