Endocrine Abstracts

Introduction: Differentiated thyroid carcinoma is usually associated with a good prognosis. However, some of these tumors (5%) are radioiodine refractory and have different progression, associated with poor prognosis. In these situations, some tyrosine kinase inhibitors (TKI) can be used. We present a clinical case showing the difficulties in the follow-up and treatment of these patients.

Clinical case: A 60 years old woman, with a “multicentric papillary cancer, with high cells”, underwent total thyroidectomy in 2000, followed by I131 ablation. TG remained undetectable but TgAb progressively higher. In 2005, lymph node cervical metastases were excised. In February 2017, Tg was still undetectable with TgAb 773 UI/ml and the 18 FDG-PET showed: “Bilateral hypermetabolic pulmonary metastases”. She started sorafenib (800 mg) in September and 4 weeks later, she presented at the emergency service with a diabetic ketoacidosis (glycemia – 895 mg/dl; pH - 6,99), and was treated with intravenous fluids and continuous insulin infusion. After stabilization, she performed blood tests: A1C - 16,2%; GAD-65 Ab - 4,48 U/ml (<1); IA-2A Ab - 2,87 U/ml (<1). As the presence of different autoantibodies suggests the diagnosis of polyglandular autoimmune syndrome (PAS), we’re waiting for the results of blood tests to exclude other autoimmune diseases. Meanwhile the level of TgAb reduced (350 UI/ml) but an urticaria reaction to sorafenib forced its reduction to 200 mg and later it was stopped. She is starting now lenvatinib.

Discussion: We present a patient with a papillary carcinoma and PAS who underwent a serious clinical manifestation of type 1 Diabetes (ketoacidosis) a few weeks after starting sorafenib. There’s some evidence about the possible effects of TKI in immunologic reactions and autoimmunity. So, we can’t exclude that this manifestation of DM could be a possible effect of this drug.