Thyroid Hormone Inactivation in Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are resistant to traditional chemotherapy but are responsive to the tyrosine kinase inhibitors imatinib and sunitinib.1 The use of these agents has improved the outcome for patients but is associated with adverse effects, including hypothyroidism.2 Multiple mechanisms of this effect have been proposed, including decreased iodine organification3 and glandular capillary regression.4 Here we report the finding of consumptive hypothyroidism caused by marked overexpression of the thyroid hormone–inactivating enzyme type 3 iodothyronine deiodinase (D3) within the tumor. Affected patients warrant increased monitoring and may require supernormal thyroid hormone supplementation.