| Autor: |
Brancatella, Alessandro, Lupi, Isabella, Montanelli, Lucia, Ricci, Debora, Viola, Nicola, Sgrò, Daniele, Antonangeli, Lucia, Sardella, Chiara, Brogioni, Sandra, Piaggi, Paolo, Molinaro, Eleonora, Bianchi, Francesca, Aragona, Michele, Antonuzzo, Andrea, Sbrana, Andrea, Lucchesi, Maurizio, Chella, Antonio, Falcone, Alfredo, Prato, Stefano del, Elisei, Rossella |
| Předmět: |
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| Zdroj: |
Journal of the Endocrine Society; Sep2021, Vol. 5 Issue 9, p1-10, 10p |
| Abstrakt: |
Context Thyrotoxicosis is a common immune-related adverse event in patients treated with programmed cell death protein-1 (PD1) or programmed cell death protein ligand-1 (PD-L1) blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy, is lacking, as are data on response to treatment and follow-up. Objective The aim of this study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and treatment. Methods We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis on PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, 99mtechnecium scintiscan, and longitudinal thyroid function tests. Results Five patients had normal or increased scintigraphic uptake (Sci+), no serum antibodies against the thyrotropin receptor, and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci–) and experienced destructive thyrotoxicosis followed by hypothyroidism (N = 9) or euthyroidism (N = 6). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P = .04). Among Sci– individuals, a larger thyroid volume was associated with a longer time to remission (P < .05). Methimazole (MMI) was effective only in Sci+ individuals (P < .05). Conclusion Administration of PD1- or PD-L1–blocking antibodies may induce 2 different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI, and a type 2, characterized by destructive and transient thyrotoxicosis that evolves to hypothyroidism or euthyroidism. Thyroid scintigraphy and ultrasound help in differentiating and managing these 2 forms of iatrogenic thyrotoxicosis. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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