Hi guys,
My mother is a multiple myeloma patient. She was on maintenance treatment with Revlimid (lenalidomide) for the last 6 months.
On January 6, 2015 we had checked her serum creatinine level and other haematology analysis. Apart from the kappa and lambda chain ratio, everything was good.
Last week she had a cold and cough; she was taking medicines for that. She is also a hypothyroidism patient.
Today when we checked her TSH level, it was way too low. It is now 0.02 mIU/mL, where the normal range should be from 0.4. Any suggestions on this?
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Karan - Name: karan
- Who do you know with myeloma?: my mother
- When were you/they diagnosed?: manipal hospital, Updupi,India
- Age at diagnosis: 53
Re: Decreased TSH level while on Revlimid maintenance
When was the last time she had her TSH level tested before this most recent test? Do you know if this is a sudden development, or could it have been something in the making over a period of years?
Some multiple myeloma drug therapies (including lenalidomide) can impact one's TSH levels.
MK Figaro et al, "Thyroid abnormalities in patients treated with lenalidomide for hematological malignancies: Results of a retrospective case review," American Journal of Hematology, June 2011 (html, pdf)
Abstract:
Lenalidomide is an antiangiogenic drug associated with hypothyroidism. We describe a case-series of lenalidomide use in hematological cancers and the prevalence of thyroid abnormalities.
We reviewed medical records of patients treated with lenalidomide at a single center form 2005 to 2010 and extracted demographic, clinical, and laboratory data. Of 170 patients with confirmed lenalidomide use (age 64.9±15 years), 148 were treated for multiple myeloma and 6% had thyroid abnormalities attributable only to lenalidomide.
In patients with a previous diagnosis of thyroid dysfunction, the addition of lenalidomide therapy was associated with a higher incidence of subsequent TFTF abnormality (17%) as compared to patients with no previous diagnosis of thyroid dysfunction (6%) (P=0.0001). Many patients (44%) with pre-existing disease and a change in thyroid function before or while on lenalidomide had no further follow-up of their thyroid abnormalities. Of 20 patients who did not undergo any thyroid finction testing either before starting or while on lenalidomide for a median of 9.4 months (±6.5), 35% developed new symptoms compatible with hypothyroidism, including worsened fating, constipation or cold intolerance.
Symptoms of thyroid dysfunction overlap with side effects of lenalidomide. Thyroid hormone levele are not regularly evaluated in patients on lenalidomide. While on this treatment, thyroid abnormalities can occur in patients with no previous diagnoses and in patients with pre-existing abnormalities. Because symptoms of thyroid dysfunction could be alleviated by appropriate treatment, thyroid function should be evaluated during the course of lenalidomide to improve patients quality of life
Some multiple myeloma drug therapies (including lenalidomide) can impact one's TSH levels.
MK Figaro et al, "Thyroid abnormalities in patients treated with lenalidomide for hematological malignancies: Results of a retrospective case review," American Journal of Hematology, June 2011 (html, pdf)
Abstract:
Lenalidomide is an antiangiogenic drug associated with hypothyroidism. We describe a case-series of lenalidomide use in hematological cancers and the prevalence of thyroid abnormalities.
We reviewed medical records of patients treated with lenalidomide at a single center form 2005 to 2010 and extracted demographic, clinical, and laboratory data. Of 170 patients with confirmed lenalidomide use (age 64.9±15 years), 148 were treated for multiple myeloma and 6% had thyroid abnormalities attributable only to lenalidomide.
In patients with a previous diagnosis of thyroid dysfunction, the addition of lenalidomide therapy was associated with a higher incidence of subsequent TFTF abnormality (17%) as compared to patients with no previous diagnosis of thyroid dysfunction (6%) (P=0.0001). Many patients (44%) with pre-existing disease and a change in thyroid function before or while on lenalidomide had no further follow-up of their thyroid abnormalities. Of 20 patients who did not undergo any thyroid finction testing either before starting or while on lenalidomide for a median of 9.4 months (±6.5), 35% developed new symptoms compatible with hypothyroidism, including worsened fating, constipation or cold intolerance.
Symptoms of thyroid dysfunction overlap with side effects of lenalidomide. Thyroid hormone levele are not regularly evaluated in patients on lenalidomide. While on this treatment, thyroid abnormalities can occur in patients with no previous diagnoses and in patients with pre-existing abnormalities. Because symptoms of thyroid dysfunction could be alleviated by appropriate treatment, thyroid function should be evaluated during the course of lenalidomide to improve patients quality of life
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Decreased TSH level while on Revlimid maintenance
Karan,
It's probably just a typo, but you said your mother's TSH level was measured to be "0.02 mIU/mL".
Usually, the units for TSH test results are mlU per liter (L), not per millileter (mL), and the normal range is 0.4 to 4.0 mlU/L.
If your mother's test results was actually 0.02 mlU/mL (rather than per L), then that is equivalent to 20 mlU/L, which would be very HIGH, not very low.
Again, I'm assuming you probably just made a typo, but I thought I would double check.
It's probably just a typo, but you said your mother's TSH level was measured to be "0.02 mIU/mL".
Usually, the units for TSH test results are mlU per liter (L), not per millileter (mL), and the normal range is 0.4 to 4.0 mlU/L.
If your mother's test results was actually 0.02 mlU/mL (rather than per L), then that is equivalent to 20 mlU/L, which would be very HIGH, not very low.
Again, I'm assuming you probably just made a typo, but I thought I would double check.
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Jonah
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