Abstract #1413778: Lenalidomide Induced Severe Hypothyroidism Resulting in Acute Ppsychosis: A Rare Side Effect

Hypothyroidism presents as slowing of bodily functions that become more severe the disease progresses. Common causes acquired hypothyroidism include autoimmune disorders, iodine deficiency, post-radiation and drug induced. We present a rare case lenalidomide induced leading to acute psychosis requiring aggressive intravenous thyroxine repletion. Sixty-four-year-old male with history follicular Non-Hodgkins Lymphoma, currently on rituximab/lenalidomide who was brought Emergency Department (ED) for hallucinations, paranoia manic symptoms three days. In ED, his vitals were stable. Computed Tomography (CT) head normal. Blood work revealed an elevated TSH at 51.70 uIU/ml (normal 0.30-5.0 uIU/ml), free T3 <0.1 pg/ml 2.0-4.4 pg/ml) T4 ng/dL 0.7-1.7 ng/dL). Thyroid peroxidase antibody 9 IU/ml <34.0 IU/ml). He started levothyroxine responded well in about forty-eight hours. During this time, he got Magnetic Resonance Imaging (MRI) brain continued IV therapy 4 weeks after which switched oral levothyroxine. His chemotherapy regimen has been changed bendamustine/rituximab. continues be is doing well. described decreased activity thyroid gland resulting retardation growth development children adults. Autoimmune disorders such Hashimoto’s thyroiditis remain cause developed countries contrast developing where deficiency goiter remains endemic. Several drugs are known amiodarone, lithium, check point inhibitors, thalidomide, interleukin-2 interferon alpha. Recently, found around five ten percent patients being reported only handful patients, most cases usually mild. The exact mechanism by it unknown, but several mechanisms have hypothesized including uptake gland, secretion, formation auto antibodies against shrinkage due ischemia. Since overlap those cancer fatigue hair loss, diagnosis can delayed or fatal complications. suggest regular monitoring patient’s profile during treatment lenalidomide, perhaps every 2-3 months suggested oncology literature.