Int J Thyroidol.  2018 Nov;11(2):71-74. 10.11106/ijt.2018.11.2.71.

Management of Bleeding Induced by Tyrosine Kinase Inhibitor in Radioiodine Refractory Thyroid Cancer

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.


Adverse events such as hemoptysis and gastrointestinal hemorrhage during tyrosine kinase inhibitor treatment are relatively rare, but the severity of the bleeding can be higher than other common adverse events. It is necessary to educate patients about its possibility so that they can be found early. In this case report of radioiodine refractory thyroid cancer patient, hemoptysis and gastrointestinal bleeding has occurred following lenvatinib administration. Drug interruption and dose modification and dose interruption were required in addition to management for bleeding itself. It is necessary to confirm the high risk of bleeding before the administration of tyrosine kinase inhibitors, and to appropriately control the follow-up interval and drug dosage accordingly.


Radioiodine refractory thyroid cancer; Tyrosine kinase inhibitor; Bleeding; Fistula

MeSH Terms

Follow-Up Studies
Gastrointestinal Hemorrhage
Protein-Tyrosine Kinases*
Thyroid Gland*
Thyroid Neoplasms*
Protein-Tyrosine Kinases


  • Fig. 1 Anterior (A) and posterior (B) post-radioiodine therapeutic scan showed no significant radioiodine uptake in distant lesion.

  • Fig. 2 CT scan revealed multiple lymph node metastases at the surgical site (B, arrows), progressive peritracheal lymph node metastasis (A, arrow) and multiple hematogenous pulmonary metastases (C–H, arrows) after five months of radioiodine therapy.

  • Fig. 3 Pneumonia and bronchiectasis were found on chest CT scan after five weeks of lenvatinib administration (A, arrow). Decreased in size of multiple nodules in both lungs (B, arrow).

  • Fig. 4 The size of the cervical mass was reduced at 5 months (B) compared to before the administration of lenvatinib (A).


1. Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014; 384(9940):319–328.
2. Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, et al. Lenvatinib versus placebo in radioiodinerefractory thyroid cancer. N Engl J Med. 2015; 372(7):621–630.
3. Launay-Vacher V, Deray G. Hypertension and proteinuria: a class-effect of antiangiogenic therapies. Anticancer Drugs. 2009; 20(1):81–82.
4. Blevins DP, Dadu R, Hu M, Baik C, Balachandran D, Ross W, et al. Aerodigestive fistula formation as a rare side effect of antiangiogenic tyrosine kinase inhibitor therapy for thyroid cancer. Thyroid. 2014; 24(5):918–922.
5. Lamartina L, Ippolito S, Danis M, Bidault F, Borget I, Berdelou A, et al. Antiangiogenic tyrosine kinase inhibitors: occurrence and risk factors of hemoptysis in refractory thyroid cancer. J Clin Endocrinol Metab. 2016; 101(7):2733–2741.
6. Barber NA, Afzal W, Akhtari M. Hematologic toxicities of small molecule tyrosine kinase inhibitors. Target Oncol. 2011; 6(4):203–215.
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