Roxadustat and thyroid-stimulating hormone suppression

[helvella]

Just posting this so that it has been posted. I have my doubts it will be relevant to more than a handful - but I could be wrong.

Roxadustat and thyroid-stimulating hormone suppression

Atsuyuki Tokuyama, Hiroyuki Kadoya, Atsushi Obata, Takahiro Obata, Tamaki Sasaki, Naoki Kashihara

Clinical Kidney Journal, Volume 14, Issue 5, May 2021, Pages 1472–1474, doi.org/10.1093/ckj/sfab007

Published: 20 January 2021

Abstract

Hypoxia-inducible factor prolyl-hydroxylase inhibitors belong to a new class of orally administered drugs for treating anemia in patients with chronic kidney disease (CKD). The prevalence of hypothyroidism is disproportionately high in patients with CKD on hemodialysis. We report a rapid suppression of thyroid-stimulating hormone (TSH) and decrease in free triiodothyronine (T3) and free tetraiodothyronine levels after switching from darbepoetin alfa to roxadustat in a hemodialysis patient with hypothyroidism on levothyroxine therapy. This was reversed after stopping roxadustat. Roxadustat has structural similarity with T3 and is a selective activating ligand for thyroid hormone receptor-β possibly suppressing TSH release.

end-stage renal disease, hemodialysis, hypothyroidism, hypoxia-inducible factor prolyl-hydroxylase inhibitor, levothyroxine sodium hydrate, roxadustat

Topic:

• anemia

• hypothyroidism

• hemodialysis

• thyroid hormones

• kidney failure, chronic

• hypoxia

• ligands

• procollagen-proline dioxygenase

• thyrotropin

• thyroxine

• free triiodothyronine

• darbepoetin alfa

Issue Section:

EXCEPTIONAL CASES

Full paper freely accessible here: academic.oup.com/ckj/articl...

[nellie237]

Thank you,

Having recently been more Iron deficient than usual due to Coeliac.............then got my levels up to really good over a couple of months .............then a few weeks later completely nosedived to anaemic due to kidney injury this is relevant to me.

NICE made a change to Interpreting Ferritin Levels in April 2021:

"In all people a serum ferritin level of less than 30ug/L confirms the diagnosis of Iron deficiency." Up until then the level used to be 15ug/L.

If anybody else is interested, there is a recent easy to understand KDIGO (Kidney Disease Improving Global Outcomes) video re Anaemia in CKD. How Hypoxia Inducible Factor (HIF) works isabout 20 mins in. Nil mention of thyroid..........no surprise.😖

youtube.com/watch?v=Wf4OwUU...(Not working as expected?)

[ Edited to make link display properly. ]