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This class has less toxicity than traditional systemic cytotoxic drugs although it is potentially correlated to thyroid dysfunction thus a multidisciplinary approach is essential in managing the patient. The initial observations that thyroid malfunction is a relatively rare reaction have been replaced to the concept that actually there is a frequent thyroid disturbance345. The thyroid involvement includes spontaneously remitting thyrotoxicosis and hypothyroidism345. The severity of the thyrotoxicosis varies considerably from one patient to another up to thyroid storm especially after sorafenib