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Apalutamide-induced severe hypothyroidism: case series and practice recommendations for thyroid management
Karel David1, Paul Van Crombrugge2, Anne-Marie Van der Biest3
1Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
European Thyroid Journal
|October 17, 2024
Summary
Apalutamide, a prostate cancer drug, can worsen hypothyroidism, especially in patients with pre-existing thyroid conditions. Close thyroid monitoring is crucial during apalutamide treatment.
Area of Science:
- Endocrinology
- Oncology
Background:
- Apalutamide is an androgen receptor signaling inhibitor used for prostate cancer treatment.
- Previous trials (SPARTAN, TITAN) indicated an increased risk of hypothyroidism with apalutamide use.
Observation:
- Three cases of subacute deterioration of well-controlled hypothyroidism were observed shortly after initiating apalutamide.
- These patients required adjustments to their levothyroxine dosage due to worsening thyroid function.
Findings:
- Apalutamide treatment can precipitate severe hypothyroidism in patients with pre-existing thyroid disease.
- The risk is significant even in cases of previously well-managed hypothyroidism.
Implications:
- Healthcare providers should be vigilant for thyroid dysfunction in patients receiving apalutamide.
- Proactive thyroid function monitoring and management are recommended before, during, and after apalutamide therapy.
- This is particularly important for patients with a history of thyroid disease.
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