Hypothyroidism caused by thalidomide in
patients with multiple myeloma
(July 2002)
The background of
the study. Thalidomide is an old drug, proven to cause birth
defects, that was recently found to have beneficial effects in patients
with multiple myeloma (a tumor of bone marrow) and other tumors.
This article describes a patient with multiple myeloma who had hypothyroidism
while receiving thalidomide and the results of measurements of serum
thyrotropin (TSH) in other patients with multiple myeloma who were
treated with thalidomide.
Case report. The patient was a 44-year-old
man with multiple myeloma who had symptoms of hypothyroidism (cold
intolerance, fatigue, depression) after four weeks of treatment
with thalidomide therapy (400 mg daily). His symptoms persisted
after the dose of thalidomide was reduced to 200 mg daily. At three
months, his serum TSH concentration was very high (115 mU/L) and
his serum thyroxine concentration was low. He was treated with T4.
How the study was done and the results
of the study. Serum TSH was measured in two groups of patients.
One group consisted of 174 patients with multiple myeloma who were
randomly assigned to receive chemotherapy and thalidomide, 400 mg
daily, or chemotherapy alone. Three to four months later, 18 of
the 92 patients (20 percent) in the chemotherapy and thalidomide
group had serum TSH concentrations >5 mU/L, as compared with
7 of the 82 patients (9 percent) in the chemotherapy-alone group.
Six patients (7 percent) in the chemotherapy and thalidomide group,
but none in the chemotherapy group, had a serum TSH concentration
>10 mU/L (range, 12 to 114).
The second group consisted of 81 patients with multiple myeloma.
During treatment with 200 to 800 mg of thalidomide daily for two
to six months, their median serum TSH concentration increased by
48 percent. Eighteen patients (22 percent) had serum TSH concentrations
>5 mU/L, and 11 (14 percent) had concentrations ≥10 mU/L.
Symptoms were not recorded and serum T4 was not measured in these
patients.
The conclusions of the study. Thalidomide
has an antithyroid action in patients with multiple myeloma.
The original article. Badros AZ,
Siegel E, Bodenner D, Zangari M, Zeldis J, Barlogie B, Tricot G.
Hypothyroidism in patients with multiple myeloma following treatment
with thalidomide. Am J Med 2002;112:412-3.
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