Citation: Endocrine Connections. 2020, 9(4), 318-25. 2020 Mar 1[Online ahead of print]
Author: Anna Olsson-Brown, Rosemary Lord, Joseph Sacco, Jonathan Wagg, Mark Coles, Munir Pirmohamed
Abstract: Intoduction: Immune checkpoint inhibitors can lead to thyroid dysfunction. However the understanding of the clinical phenotype of ICI-induced thyroid dysfunction in the real-world population is limited. The purpose of this study was to characterise the clinical patterns of dysfunction and evaluate the demographic, biochemical and immunological features associated with this patient cohort.
Materials and methods: To characterise the longitudinal clinical course of thyroid dysfunction in patients from a single, UK regional cancer centre a retrospective review of patients was conducted. Inclusion criteria included all patients treated with antiPD-1 checkpoint inhibitors (ICI), either as monotherapy (pembrolizumab/nivolumab) or in combination with a CTLA-4 inhibitor (ipilimumab). Patterns of toxicity were evaluated together with assessment of antibody titres.
Results: Over 16 months, thyroid dysfunction was seen in 13/90 and 3/13 patients treated with anti-PD1 monotherapy, and in combination with the anti-CTLA4 ICI ipilimumab, respectively. Patients either developed hyperthyroidism followed by hypothyroidism 12/16 or de novo hypothyroidism 4/16. Most patients were female (n=11). All patients required thyroid replacement therapy. There was no relationship between clinical pattern of dysfunction and the presence of thyroid autoantibodies.
Conclusions: There are two distinct patterns of thyroid dysfunction in ICI-treated patients. Patients with thyroiditis develop subsequent hypothyroidism in the vast majority of cases. The potential benefit from steroids or other therapy to manage the hyperthyroid phase remains unclear. Early detection of these patients through appropriate monitoring will improve clinical management and early hormone replacement reducing the symptomatic burden of hypothyroidism.
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