Roxadustat and thyroid-stimulating hormone suppression

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-beta possibly suppressing TSH release.

Automated summary

This study found that in CKD patients, switching from darbepoetin alfa to roxadustat may lead to abnormal levels of thyroid-stimulating hormone in hemodialysis patients, which can be reversed after stopping the medication.