{"id":1325,"date":"2026-01-24T08:35:20","date_gmt":"2026-01-24T08:35:20","guid":{"rendered":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/2026\/01\/24\/pneumothorax-due-to-massive-tumor-lysis-in-a-patient-with-sorafenib-therapy-for-metastasized-differe\/"},"modified":"2026-01-24T08:35:20","modified_gmt":"2026-01-24T08:35:20","slug":"pneumothorax-due-to-massive-tumor-lysis-in-a-patient-with-sorafenib-therapy-for-metastasized-differe","status":"publish","type":"post","link":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/2026\/01\/24\/pneumothorax-due-to-massive-tumor-lysis-in-a-patient-with-sorafenib-therapy-for-metastasized-differe\/","title":{"rendered":"PNEUMOTHORAX DUE TO MASSIVE TUMOR LYSIS IN A PATIENT WITH SORAFENIB THERAPY FOR METASTASIZED DIFFERENTIATED THYROID CARCINOMA"},"content":{"rendered":"
Hoftijzer H.1<\/sup>, Heemstra K.1<\/sup>, Blaauwwiekel E.2<\/sup>, Corssmit E.1<\/sup>, Romijn J.1<\/sup>, Smit J.1<\/sup><\/div>\n
1<\/sup>Department of Endocrinology and metabolism, Leiden University medical Center, Leiden, The Netherlands, 2<\/sup>Department of Internal Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands<\/div>\n
\n

Abstract<\/h2>\n

Background:<\/strong> Treatment options for metastases of differentiated thyroid carcinoma with absent uptake of radioiodine (RaI) are limited. Broad spectrum tyrosine kinase inhibitors may offer new perspectives. Clinical case A 54-year old woman with a metastasized T4N1M0 H?rthle cell follicular thyroid carcinoma was referred to the Leiden University Medical Center for experimental treatment with Sorafenib. Initial treatment consisted of irradical total thyroidectomy and a modified radical neck dissection (18 \/42 lymph nodes positive). She was subsequently treated with 5550 MBq RaI. At that time the stimulated thyroglobulin (Tg) level was 28 µg\/l (n<0.5 µg\/l). RaI therapy was repeated once, without uptake on whole body scanning. The unstimulated Tg increased to 7.7 µg\/l and a CT scan showed multiple pulmonary and lymph node metastases. Hereafter the Tg was regularly measured, without further treatment. At referral her unstimulated Tg was 1664 µg\/l. A Thyrogen stimulated 185 MBq RaI whole body scan showed no uptake and Tg was 4154 µg\/l. CT scanning showed progression of the extensive pulmonary metastases. She started Sorafenib 400 mg bid. After 4 weeks Sorafenib therapy, her unstimulated Tg increased to 5440 μg\/l. She suffered from adverse side effects including: grade II mucositis; hypocalcaemia; grade II hand-foot-reaction. Unexpectedly, 8 weeks after start of therapy, unstimulated Tg rose to 99.900 μg\/l with an increased lactate dehydrogenase (LDH) of 725 U\/l (n 200-450 U\/l).She was dyspnoeic and had pleural chest pain. A chest CT revealed an impressive decrease in number, size and density of all metastases. Surprisingly, a spontaneous pneumothorax in both lungs was present.
Conclusion:<\/strong> In this case we demonstrated an impressive regression of metastases of a H?rthle cell carcinoma after Sorafenib treatment. The immense rise in Tg and LDH can be attributed to tumorlysis. Furthermore, the decline in tumorload apparently induced visceral pleura defects, leading to a double pneumothorax. <\/div>\n","protected":false},"excerpt":{"rendered":"

Hoftijzer H.1, Heemstra K.1, Blaauwwiekel E.2, Corssmit E.1, Romijn J.1, Smit J.1 1Department of Endocrinology and metabolism, Leiden University medical Center, Leiden, The Netherlands, 2Department of Internal Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands Abstract Background: Treatment options for metastases of differentiated thyroid carcinoma with absent uptake of radioiodine (RaI) are limited. Broad spectrum tyrosine Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[45,2,9],"tags":[],"class_list":["post-1325","post","type-post","status-publish","format-standard","hentry","category-volume-7-issue-3","category-journal-articles","category-volume-7"],"_links":{"self":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/posts\/1325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/comments?post=1325"}],"version-history":[{"count":0,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/posts\/1325\/revisions"}],"wp:attachment":[{"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/media?parent=1325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/categories?post=1325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/wp-json\/wp\/v2\/tags?post=1325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}