# Progressive Destructive Hypothyroidism Associated with Sunitinib Therapy: A Three-Year Case Analysis

## TL;DR

A patient on sunitinib therapy for kidney cancer developed progressive thyroid destruction over three years, requiring hormone replacement.

## Contribution

This case study provides longitudinal evidence of progressive destructive hypothyroidism caused by sunitinib therapy.

## Key findings

- Thyroid-stimulating hormone (TSH) levels increased significantly during sunitinib treatment.
- Thyroid gland volume decreased from 18 mL to 2 mL over three years.
- Levothyroxine replacement maintained euthyroidism while allowing continued cancer treatment.

## Abstract

Sunitinib, a tyrosine kinase inhibitor (TKI) targeting vascular endothelial growth factor receptors (VEGFRs) and platelet-derived growth factor receptors (PDGFRs), is widely used in renal cell carcinoma. A broad spectrum of thyroid dysfunctions has been observed during TKI therapy, yet their mechanisms and clinical progression remain only partially explained. A longitudinal case analysis of a woman with metastatic clear-cell renal cell carcinoma treated with cyclical sunitinib therapy (4 weeks on, 2 weeks off) was performed. Thyroid function tests, clinical symptoms, and ultrasound imaging findings were evaluated over time and compared with treatment exposure and dose adjustments. Baseline thyroid function was normal. During the third cycle, thyroid-stimulating hormone (TSH) increased markedly (33.44–41.26 mIU/L), with free thyroid hormones initially remaining within reference limits. TSH fluctuations corresponded to treatment intervals before stabilising into persistent hypothyroidism requiring levothyroxine replacement. Thyroid ultrasound revealed progressive parenchymal destruction and a reduction in gland volume from 18 mL to approximately 2 mL over three years. Endocrine management enabled maintenance of biochemical euthyroidism, and systemic oncological treatment continued without interruption. Sunitinib treatment may lead to progressive destructive hypothyroidism. Routine surveillance of thyroid function is essential, and timely levothyroxine therapy facilitates continued anticancer treatment and symptom control.