Unique alterations of thyroid function parameters after i.v. administration of alkylating drugs (cyclophosohamide and ifosfamide)

Alkylating drugs (cyclophosphamide and ifosfamide) have been in clinical us e for the treatment of malignant diseases in the past. They are most useful anticancer agents and cyclophosphamide is also widely used for its immunos uppressive properties. However the effect of alkylating drugs on thyroid ho rmone parameters have not been evaluated so far. Three groups of patients were prospectively evaluated: Group I: 15 patients with Wegener's granulomatosis and 4 patients with severe scleritis receive d a single dose cyclophosphamide (15 mg/kg bw/day) and 250 mg prednisone i. v. Group II: 9 patients with malignant lymphomas were treated according to the IMVP 16-protocol. Patients received daily ifosfamide 1000 mg/m(2) from day 0 to 4 and vepesid from day 0 to 2. Patients did not receive corticoste roids additionally. Group III: 6 patients with a relapse of malignant lymph omas received ifosfamide 1.500 mg/m(2)/day from day 0 to 4 i.v. and dexamet hasone 40 mg/m(2) as well as ara-c and etoposid. All patients received mesna to prevent hemorrhagic cystitis and odansetran or metoclopramide as antiemetic drugs. Alkylating drugs were given as a one hour infusion. Thyroid hormone parameters were determined before and on da y 1, 2, 3, 4 after drug administration. We observed a significant increase in T4 and fT4 concentrations and a conco mitant fall in TSH in either group one day after the administration of alky lating drugs. The effect was most pronounced in group III: T4 increased fro m 113 +/- 8 nmol/L to 175 +/- 8 (normal: 58-154) and fT4 from 14.0 +/- 0.8 to 24.8 +/- 2.5 pmol/L (normal 10-25). TSH dropped from 1.27 +/- 0.16 to 0. 33 +/- 0.07 mU/L (normal 0.3-4). All changes were significant: p < 0.001. T wo of the six patients displayed biochemical hyperthyroidism. Also reverse T3 increased significantly. Two days after drug administration a gradual no rmalization occurred. However, T3, Tg, TBG, Transthyretin and albumin level s did not change throughout the study period. One patient with coexisting h ypothyroidism, who received his last thyroxine substitution therapy one day before the administration of cyclophosphamide las in group I), also demons trated an increase in T4, fT4 and rT3 and a fall in TSH concentrations. Iv. administrations of cyclophosphamide and ifosfamide induce a transient i ncrease in T4 and fT4 concentrations and a concomitant fall of TSH in the p resence of normal Tg, T3 and thyroid binding protein concentrations. These data suggest, that the changes are not due to a release of thyroid hormones from the thyroid itself, but is likewise related to a release of thyroxine from cellular pools such as the liver.