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Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Lutetium 177 (<jats:sup>177<\/jats:sup>Lu) - DOTATATE is a form of peptide receptor radionuclide therapy (PRRT) utilized in the treatment of neuroendocrine tumors. Data on <jats:sup>177<\/jats:sup>Lu-DOTATATE-induced thyroid dysfunction is limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Description<\/jats:title><jats:p>A 29-year-old male with <jats:italic>SDHB<\/jats:italic>\u00a0positive metastatic paraganglioma enrolled under the <jats:sup>177<\/jats:sup>Lu-DOTATATE trial (NCT03206060) underwent thyroid function test (TFT) evaluation comprised of thyroid stimulating hormone (TSH) and free thyroxine (FT4) immunoassay measurements per protocol prior to <jats:sup>177<\/jats:sup>Lu-DOTATATE therapy. The TSH was suppressed [&amp;lt;0.01 \u00b5IU\/ml (0.27\u20134.2 \u00b5IU\/ml)], and FT4 was normal [1.3 ng\/dl (0.9\u20131.7 ng\/dl)]. The TSH receptor antibody and thyroid stimulating immunoglobulin index were undetectable [&amp;lt;1 IU\/L (\u22641.75 IU\/L), and &amp;lt;1 (\u22641.3) respectively], while the anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies were elevated [605 IU\/ml (0.0\u201334.9 IU\/ml), and 178 IU\/ml (0.0-40.0 IU\/ml) respectively]. Mass spectrometry on a stored (-80\u00b0C) plasma sample obtained one-month pre-PRRT revealed elevated total triiodothyronine (TT3) [235 ng\/dl (65\u2013193 ng\/dl)] and FT4 [3.9 ng\/dl (1.2\u20132.9 ng\/dl)] levels. The patient was diagnosed with Hashimoto\u2019s thyrotoxicosis. However, the patient was asymptomatic. One month after the first dose of 200mCi <jats:sup>177<\/jats:sup>Lu-DOTATATE, the patient noted fatigue and a 2.6 Kg weight gain. The TSH (73.04 \u00b5IU\/ml), anti-TPO antibodies (&amp;gt;1,000 IU\/ml), and anti-Tg antibodies (668 IU\/ml) had substantially increased, with reductions in FT4 (0.3 ng\/dl) and TT3 [54 ng\/dl (87\u2013169 ng\/dl)]. Diagnostic gallium 68 - DOTATATE positron emission tomography-computed tomography performed prior to <jats:sup>177<\/jats:sup>Lu-DOTATATE treatment revealed diffuse thyroid uptake. Post-therapy single-photon emission computed tomography also revealed diffuse uptake of\u00a0<jats:sup>177<\/jats:sup>Lu-DOTATATE in the thyroid gland. Levothyroxine therapy was initiated, and the patient\u2019s symptoms resolved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>We report, for the first time, a patient with asymptomatic primary hyperthyroidism who rapidly developed symptomatic primary hypothyroidism 1 month after <jats:sup>177<\/jats:sup>Lu-DOTATATE therapy, accompanied by marked changes in TFTs and thyroid auto-antibody titers, with functional imaging evidence of diffuse uptake of <jats:sup>177<\/jats:sup>Lu-DOTATATE in the thyroid gland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Thyroid dysfunction can be associated with PRRT. Thyroid uptake patterns on pre-treatment diagnostic somatostatin analog scans might predict individual susceptibility to PRRT-associated TFT disruption. Therefore, periodic evaluation of TFTs should be considered in patients receiving PRRT.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2020.587065","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T10:58:12Z","timestamp":1611226692000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Case Report: Primary Hypothyroidism Associated With Lutetium 177-DOTATATE Therapy for Metastatic Paraganglioma"],"prefix":"10.3389","volume":"11","author":[{"given":"Sriram","family":"Gubbi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Al-Jundi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaydira","family":"Del 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