{"doi":"10.3389/fendo.2020.587065","title":"Case Report: Primary Hypothyroidism Associated With Lutetium 177-DOTATATE Therapy for Metastatic Paraganglioma","abstract":"Background Lutetium 177 ( 177 Lu) - DOTATATE is a form of peptide receptor radionuclide therapy (PRRT) utilized in the treatment of neuroendocrine tumors. Data on 177 Lu-DOTATATE-induced thyroid dysfunction is limited. Case Description A 29-year-old male with SDHB positive metastatic paraganglioma enrolled under the 177 Lu-DOTATATE trial (NCT03206060) underwent thyroid function test (TFT) evaluation comprised of thyroid stimulating hormone (TSH) and free thyroxine (FT4) immunoassay measurements per protocol prior to 177 Lu-DOTATATE therapy. The TSH was suppressed [<0.01 µIU/ml (0.27–4.2 µIU/ml)], and FT4 was normal [1.3 ng/dl (0.9–1.7 ng/dl)]. The TSH receptor antibody and thyroid stimulating immunoglobulin index were undetectable [<1 IU/L (≤1.75 IU/L), and <1 (≤1.3) respectively], while the anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies were elevated [605 IU/ml (0.0–34.9 IU/ml), and 178 IU/ml (0.0-40.0 IU/ml) respectively]. Mass spectrometry on a stored (-80°C) plasma sample obtained one-month pre-PRRT revealed elevated total triiodothyronine (TT3) [235 ng/dl (65–193 ng/dl)] and FT4 [3.9 ng/dl (1.2–2.9 ng/dl)] levels. The patient was diagnosed with Hashimoto’s thyrotoxicosis. However, the patient was asymptomatic. One month after the first dose of 200mCi 177 Lu-DOTATATE, the patient noted fatigue and a 2.6 Kg weight gain. The TSH (73.04 µIU/ml), anti-TPO antibodies (>1,000 IU/ml), and anti-Tg antibodies (668 IU/ml) had substantially increased, with reductions in FT4 (0.3 ng/dl) and TT3 [54 ng/dl (87–169 ng/dl)]. Diagnostic gallium 68 - DOTATATE positron emission tomography-computed tomography performed prior to 177 Lu-DOTATATE treatment revealed diffuse thyroid uptake. Post-therapy single-photon emission computed tomography also revealed diffuse uptake of 177 Lu-DOTATATE in the thyroid gland. Levothyroxine therapy was initiated, and the patient’s symptoms resolved. Summary We report, for the first time, a patient with asymptomatic primary hyperthyroidism who rapidly developed symptomatic primary hypothyroidism 1 month after 177 Lu-DOTATATE therapy, accompanied by marked changes in TFTs and thyroid auto-antibody titers, with functional imaging evidence of diffuse uptake of 177 Lu-DOTATATE in the thyroid gland. Conclusions Thyroid dysfunction can be associated with PRRT. Thyroid uptake patterns on pre-treatment diagnostic somatostatin analog scans might predict individual susceptibility to PRRT-associated TFT disruption. Therefore, periodic evaluation of TFTs should be considered in patients receiving PRRT.","journal":"Frontiers in Endocrinology","year":2021,"id":194524,"datarank":0.7226763341981424,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.3772885702490355,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.3772885702490355,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":8,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9583,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03206060"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":764427,"name":"Mohammad Al-Jundi","orcid":"0000-0002-7076-6488","position":1,"is_corresponding":false},{"id":574623,"name":"Jaydira Del Rivero","orcid":"0000-0002-9065-6753","position":2,"is_corresponding":false},{"id":302290,"name":"Abhishek Jha","orcid":"0000-0001-9161-0450","position":3,"is_corresponding":false},{"id":351472,"name":"Marianne Knue","orcid":"0000-0002-8898-8767","position":4,"is_corresponding":false},{"id":765082,"name":"Joy Zou","orcid":null,"position":5,"is_corresponding":false},{"id":110339,"name":"Barış Türkbey","orcid":"0000-0003-0853-6494","position":6,"is_corresponding":false},{"id":308731,"name":"Jorge A. Carrasquillo","orcid":"0000-0002-8513-5734","position":7,"is_corresponding":false},{"id":765083,"name":"Emily M. Lin","orcid":null,"position":8,"is_corresponding":false},{"id":435576,"name":"A. Jha","orcid":"0000-0002-1489-2471","position":9,"is_corresponding":false},{"id":255444,"name":"Joanna Kłubo-Gwieździńska","orcid":"0000-0001-8633-4420","position":10,"is_corresponding":false},{"id":464208,"name":"Frank I. Lin","orcid":"0000-0003-3539-1454","position":11,"is_corresponding":false},{"id":108961,"name":"Sriram Gubbi","orcid":"0000-0002-9263-1381","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-18T23:49:59.476757Z","pmid":"33551992","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}