{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:18:00Z","timestamp":1784557080013,"version":"3.55.0"},"reference-count":12,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["eo.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2,14]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Systemic thrombotic microangiopathy (TMA) is a serious condition whose early treatment is essential to reduce morbidity and mortality. TMA with only renal involvement has been associated with tyrosine kinase inhibitors, including lenvatinib, a drug used for certain advanced neoplasms. To date, TMA with systemic involvement associated with this drug has not been described. We present the case of a patient with progressive metastatic thyroid cancer who developed this complication after starting treatment with lenvatinib. We describe the signs and symptoms that led to the diagnosis and the treatment required for her recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Thrombotic microangiopathy (TMA) is a group of disorders characterized by thrombosis in capillaries and arterioles due to an endothelial injury. Both, localized and systemic forms have been described.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>TMA with systemic involvement is characterized by hemolytic anemia, low platelets, and organ damage.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Vascular endothelial growth factor signaling inhibitors have been associated with TMA, either restricted to the kidney or with systemic involvement.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Lenvatinib has been rarely associated with TMA. Although only forms with isolated or predominantly renal involvement had been described so far, a predominantly systemic form can occur.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Lenvatinib-induced systemic TMA must be distinguished from primary forms by measuring ADAMTS-13. Treatment includes discontinuation of the drug and supportive measures.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>When anemia and thrombocytopenia coexist in a patient receiving treatment with lenvatinib, a peripheral blood smear to exclude TMA is recommended<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/eo-22-0078","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T07:08:06Z","timestamp":1676358486000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-15","source":"Crossref","is-referenced-by-count":3,"title":["Thrombotic microangiopathy associated with lenvatinib therapy"],"prefix":"10.1530","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7032-1916","authenticated-orcid":true,"given":"Macarena","family":"Contreras Angulo","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8124-4271","authenticated-orcid":true,"given":"Bel\u00e9n","family":"Garc\u00eda Izquierdo","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7479-4101","authenticated-orcid":true,"given":"Laura","family":"Armengod Grao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7366-2476","authenticated-orcid":true,"given":"Nuria","family":"Palacios Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Medicina Clinica","first-page":"331.e1","article-title":"Diagnostic and therapeutic guidelines of thrombotic microangiopathies of the Spanish Apheresis Group","volume":"144","author":"Contreras","year":"2015","unstructured":"Contreras Ede la Rubia JDel R\u00edo-Garma JD\u00edaz-Ricard MGarc\u00eda-Gala JMLozano M & Grupo Espa\u00f1ol de Af\u00e9resis2015Diagnostic and therapeutic guidelines of thrombotic microangiopathies of the Spanish Apheresis Group. Medicina Clinica144331.e1\u2013331.e13. (https:\/\/doi.org\/10.1016\/j.medcli.2014.09.013)"},{"key":"bib2","series-title":"Virchows Archiv","first-page":"467","article-title":"Lenvatinib-related renal microangiopathy: a case series","volume":"480","author":"Delsante","year":"2021","unstructured":"Delsante MMonroy-Trujillo JMCarter-Monroe NBall DW & Rosenberg AZ2021Lenvatinib-related renal microangiopathy: a case series. Virchows Archiv480467\u2013473. (https:\/\/doi.org\/10.1007\/s00428-021-03114-5)"},{"key":"bib3","series-title":"New England Journal of Medicine","first-page":"1129","article-title":"VEGF inhibition and renal thrombotic Mhhicroangiopathy","volume":"358","author":"Eremina","year":"2008","unstructured":"Eremina VJefferson JAKowalewska JHochster HHaas MWeisstuch JRichardson CKopp JBKabir MGBackx PH, 2008VEGF inhibition and renal thrombotic Mhhicroangiopathy. New England Journal of Medicine3581129\u20131136. (https:\/\/doi.org\/10.1056\/NEJMoa0707330)"},{"key":"bib7","article-title":"Lenvima, INN-lenvatinib","year":"2022","unstructured":"European Medicine Agency. Lenvima, INN-lenvatinib. Amsterdam, Netherlands: European Medicine Agency, 2022. (available at: www.ema.europa.eu\/en\/documents\/product-information\/lenvima-epar-product-information_es.pdf)"},{"key":"bib4","series-title":"Case Reports in Nephrology and Dialysis","first-page":"227","article-title":"Nintedanib-induced renal thrombotic microangiopathy","volume":"11","author":"Fujita","year":"2021","unstructured":"Fujita TNakagawa HYokota TUmetani JNagawa DNakata MNarita-Kinjo IMurakami RShimada MNakamura N, 2021Nintedanib-induced renal thrombotic microangiopathy. Case Reports in Nephrology and Dialysis11227\u2013232. (https:\/\/doi.org\/10.1159\/000517692)"},{"key":"bib5","series-title":"Thyroid","first-page":"1","article-title":"2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer","volume":"26","author":"Haugen","year":"2016","unstructured":"Haugen BRAlexander EKBible KCDoherty GMMandel SJNikiforov YEPacini FRandolph GWSawka AMSchlumberger M, 20162015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid261\u2013133. (https:\/\/doi.org\/10.1089\/thy.2015.0020)"},{"key":"bib6","series-title":"Case Reports in Oncology","first-page":"735","article-title":"Thrombotic microangiopathy with severe proteinuria induced by lenvatinib for radioactive iodine-refractory papillary thyroid carcinoma","volume":"11","author":"Hyogo","year":"2018","unstructured":"Hyogo YKiyota NOtsuki NGoto SImamura YChayahara NToyoda MNibu KIHyodo THara S, 2018Thrombotic microangiopathy with severe proteinuria induced by lenvatinib for radioactive iodine-refractory papillary thyroid carcinoma. Case Reports in Oncology11735\u2013741. (https:\/\/doi.org\/10.1159\/000494080)"},{"key":"bib8","series-title":"Frontiers in Pharmacology","article-title":"Drug-induced thrombotic microangiopathy: an updated review of causative drugs, pathophysiology, and management","volume":"13","author":"Mazzierli","year":"2023","unstructured":"Mazzierli TAllegretta FMaffini E & Allinovi M2023Drug-induced thrombotic microangiopathy: an updated review of causative drugs, pathophysiology, and management. Frontiers in Pharmacology13 1088031. (https:\/\/doi.org\/10.3389\/fphar.2022.1088031)"},{"key":"bib9","series-title":"New England Journal of Medicine","first-page":"589","article-title":"Thrombotic microangiopathies","volume":"347","author":"Moake","year":"2002","unstructured":"Moake JL2002Thrombotic microangiopathies. New England Journal of Medicine347589\u2013600. (https:\/\/doi.org\/10.1056\/NEJMra020528)"},{"key":"bib10","series-title":"Internal Medicine (Tokyo, Japan)","first-page":"3083","article-title":"Thrombotic microangiopathy, podocytopathy, and damage to the renal tubules with severe proteinuria and acute renal dysfunction induced by lenvatinib","volume":"61","author":"Nakashima","year":"2022","unstructured":"Nakashima SSekine ASawa NKawamura YKono KKinowaki KKawada MHasegawa EAkuta NSuzuki Y, 2022Thrombotic microangiopathy, podocytopathy, and damage to the renal tubules with severe proteinuria and acute renal dysfunction induced by lenvatinib. Internal Medicine (Tokyo, Japan)613083\u20133088. (https:\/\/doi.org\/10.2169\/internalmedicine.8365-21)"},{"key":"bib11","series-title":"New England Journal of Medicine","first-page":"621","article-title":"Lenvatinib versus placebo in radioiodine-refractory thyroid cancer","volume":"372","author":"Schlumberger","year":"2015","unstructured":"Schlumberger MTahara MWirth LJRobinson BBrose MSElisei RHabra MANewbold KShah MHHoff AO, 2015Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. New England Journal of Medicine372621\u2013630. (https:\/\/doi.org\/10.1056\/NEJMoa1406470)"},{"key":"bib12","series-title":"Translational Oncology","article-title":"Thrombotic microangiopathy in oncology - a review","volume":"14","author":"Val\u00e9rio","year":"2021","unstructured":"Val\u00e9rio PBarreto JPFerreira HChuva TPaiva A & Costa JM2021Thrombotic microangiopathy in oncology - a review. Translational Oncology14 101081. (https:\/\/doi.org\/10.1016\/j.tranon.2021.101081)"}],"container-title":["Endocrine Oncology"],"original-title":[],"link":[{"URL":"https:\/\/eo.bioscientifica.com\/view\/journals\/eo\/3\/1\/EO-22-0078.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eo.bioscientifica.com\/view\/journals\/eo\/3\/1\/EO-22-0078.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/eo.bioscientifica.com\/view\/journals\/eo\/3\/1\/EO-22-0078.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:50:28Z","timestamp":1784555428000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/eo\/article\/1542"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,1]]},"references-count":12,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.1530\/eo-22-0078","relation":{},"ISSN":["2634-4793"],"issn-type":[{"value":"2634-4793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,1]]}}}