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Case Reports
. 2024 Oct 16;13(5):e240158.
doi: 10.1530/ETJ-24-0158. Print 2024 Oct 1.

Apalutamide-induced severe hypothyroidism: case series and practice recommendations for thyroid management

Karel David  1 , Paul Van Crombrugge  2 , Anne-Marie Van der Biest  3 , Frederiek D'Hondt  4 , Frank Claessens  5 , Alexander Giesen  6 , Steven Joniau  6 , Brigitte Decallonne  1
Affiliations
Case Reports

Apalutamide-induced severe hypothyroidism: case series and practice recommendations for thyroid management

Karel David et al. Eur Thyroid J. .

Abstract

The androgen receptor signaling inhibitor apalutamide is used successfully for the treatment of prostate cancer. An increased risk of hypothyroidism, mostly subclinical, has been reported in the SPARTAN and TITAN trials. We present three cases of subacute deterioration of previously known but well-controlled hypothyroidism treated with levothyroxine, occurring shortly after the initiation of treatment with apalutamide, resulting in severe hypothyroidism. These cases highlight the importance of awareness of thyroid dysfunction during treatment with apalutamide, particularly in patients with pre-existing thyroid disease, common in the general population. We provide practice recommendations for thyroid management prior to and during apalutamide treatment as well as after the interruption of this therapy.

Keywords: apalutamide; glucuronidation; hypothyroidism; levothyroxine; prostate cancer.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of these case series and practice recommendations.

Figures

Figure 1
Figure 1
Practice recommendations for thyroid management in apalutamide-treated prostate cancer patients.
See this image and copyright information in PMC

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