Suppression of thyrotropin secretion during roxadustat treatment for renal anemia in a patient undergoing hemodialysis
Mitsuru Ichii, Katsuhito Mori, Daichi Miyaoka, Mika Sonoda, Yoshihiro Tsujimoto, Shinya Nakatani, Tetsuo Shoji, Masanori Emoto
Abstract
BACKGROUND: Inhibition of hypoxia-inducible factor prolyl hydroxylase (HIF-PH) is a novel choice for the treatment of renal anemia, and an oral HIF-PH inhibitor roxadustat was approved for renal anemia. Roxadustat has high affinity to thyroid hormone receptor beta, which may affect thyroid hormone homeostasis. CASE PRESENTATION: We present here a patient undergoing hemodialysis with primary hypothyroidism receiving levothyroxine replacement, who showed decreased free thyroxine (FT4) and thyroid stimulating hormone (TSH) after starting roxadustat. Pituitary stimulation test revealed selective suppression of TSH secretion. Recovery of TSH and FT4 levels after stopping roxadustat suggested the suppression of TSH was reversible. CONCLUSIONS: Physicians should pay special attention to thyroid hormone abnormalities in treatment with roxadustat.