Published online Apr 24, 2021. doi: 10.5306/wjco.v12.i4.272
Peer-review started: December 22, 2020
First decision: January 11, 2021
Revised: January 30, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 24, 2021
The management of metastatic progressive radioiodine-resistant differentiated thyroid cancer remains challenging for clinicians. The availability of tyrosine kinase inhibitors (TKIs), sorafenib and lenvatinib, within the last decade has expanded treatment options; however, these lead to significant adverse effects, which may curtail their use.
We report the case of a 47-year-old female with Hurthle cell thyroid cancer who underwent total thyroidectomy followed by radioiodine ablation. During follow-up, she developed noniodine-avid renal and pulmonary metastases. With respect to her pre-existing diabetes, hypertension, and polycystic kidney disease, the tumor board decided against performing renal metastasectomy because of the risk of future renal decline requiring dialysis. Metastases were treated using sorafenib, which provided stability followed by progression within a year. We switched to lenvatinib, which led to disease regression. However, the patient experienced severe adverse effects, including cardiomyopathy, bicytopenia, renal impairment, and the rarely reported nephrotic syndrome. Renal metastasis is a rare manifes-tation of Hurthle cell thyroid cancer with only two reported cases in literature. We report the experience of our first case of renal metastasis and its treatment with TKIs. This case serves as a reminder of the adverse drug reactions associated with TKI use.
We advocate close monitoring of patients’ hematological and renal profiles as well as their cardiac status using an echocardiogram.
Core Tip: The present case study provides a unique learning and case management experience. Our patient had widespread metastasis from a histopathologically low-risk thyroid cancer coupled with two decades of survival despite noniodine-avid metastasis, treatment of renal metastasis with tyrosine kinase inhibitors, and the development of multisystem adverse events, including rare nephrotic syndrome.