Central hypothyroidism caused by roxadustat

Isolated central hypothyroidism, although rare, has been documented in case reports in patients with chronic kidney disease (CKD) treated with roxadustat, a novel agent in the treatment of renal anaemia.

A woman in her sixties with CKD stage 5 (not in dialysis) and no prior thyroid disease, was started on treatment with roxadustat 70 mg x 3 weekly for renal anaemia. During treatment, the patient developed classic signs of hypothyroidism (fatigue, dry skin, constipation, difficulty concentrating), with blood samples consistent with isolated central hypothyroidism. Roxadustat was discontinued awaiting further investigation. One month later the patient's symptoms had resolved, and six weeks later thyroid hormones had normalised. The patient was subsequently started on a regular erythropoiesis-stimulating agent.

This example highlights the importance of routine monitoring of thyroid function in patients with CKD receiving roxadustat. Importantly, the condition resolved upon discontinuation of the medication.