Immune-Related Thyroiditis with Immune Checkpoint Inhibitors
Open accessAbstract
BACKGROUND: Although immune-related thyroiditis (irT) with immune checkpoint inhibitors (ICI) is a common consequence, its natural course and management recommendations are not well characterized in existing guidelines. This study sought to investigate the evolution of irT and describe its course and sequelae. METHODS: This was a retrospective study of cancer patients treated with ICI between November 2014 and July 2016 at MD Anderson Cancer Center and referred for endocrinology evaluation for suspected irT. Patients included had normal baseline thyroid function tests prior to starting ICI and developed thyrotoxicosis due to irT. RESULTS: Of 657 patients treated with ICI during the study period, 43(6.5%) met the inclusion criteria. ICI included: ipilimumab + nivolumab (40%), nivolumab (33%), pembrolizumab (21%), and other (7%). Cancer diagnoses observed were melanoma (23%), renal-cell carcinoma (21%), lung cancer (19%), bladder cancer (12%), colon cancer (9%), and other cancers (15%). Median time from ICI start to thyrotoxicosis was 5.3 weeks (range 0.6-19.6 weeks). Clinically, patients presented with painless thyroiditis, and 67% were asymptomatic during the thyrotoxicosis phase. Thyrotoxicosis lasted a median of six weeks (range 2.6-39.7 weeks). Hypothyroidism developed in 37 (84%) patients at a median of 10.4 weeks (range 3.4-48.7 weeks) after starting ICI. These patients remained on levothyroxine and ICI at a median follow-up of 57.4 weeks (range 1-156.7 weeks) from hypothyroidism onset. Four patients recovered without initiating levothyroxine and remained euthyroid at a median follow-up of 11.35 months (range 4.43-14.43 months). Subgroup analysis of ipilimumab + nivolumab versus nivolumab alone showed a median time to thyrotoxicosis of two weeks [confidence interval (CI) 3.5-8.4] versus six weeks ([CI 1.2-2.8]; p = 0.26) and time to hypothyroidism of 10 weeks [CI 8.1-11.9] versus 17 weeks ([CI 8.8-25.2]; p = 0.029) after starting ICI. Thyroid peroxidase and thyroglobulin antibodies were present in 45% and 33% at the time of irT diagnosis. CONCLUSIONS: IrT manifests as an early onset of thyrotoxicosis, which is largely asymptomatic, followed by rapid transition to hypothyroidism requiring long-term levothyroxine substitution. The evolution of irT is more rapid with combination ICI. Frequent monitoring of thyroid function tests during ICI is warranted. Future guidelines need to recognize this entity and incorporate their management.
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In a genetic risk score analysis, a patient with immune checkpoint inhibitor-associated diabetes mellitus had a score below the 5th percentile for patients with type 1 diabetes.
“the ICI-DM patient had a GRS below the 5th percentile for patients with T1D 75”
From Endocrine toxicities of immune checkpoint inhibitors (2021) · cites this paper as [75]
Genetic risk factors for immune checkpoint inhibitor-associated diabetes mellitus may differ from those for classic type 1 diabetes.
“suggesting that genetic risk factors for ICI-DM may differ from classic T1D”
From Endocrine toxicities of immune checkpoint inhibitors (2021) · cites this paper as [75]
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Endocrinopathies Associated With Immune Checkpoint Inhibitor Use
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- Authors
- Iyer, P. C., Cabanillas, M. E., Waguespack, S. G., Hu, M. I., Thosani, S., Lavis, V. R., Busaidy, N. L., Subudhi, S. K., Diab, A., & Dadu, R.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Dadu, Ramona
- ORCID
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2018-10
- Volume
- 28
- Issue
- 10
- Pages
- 1243-1251
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- PMC
- PMC6157359
- OpenAlex
- W2888278822
- Cited by
- 238
- References
- 26
- Citations by year
- 2026: 26 · 2025: 35 · 2024: 22 · 2023: 33 · 2022: 41 · 2021: 40 · 2020: 26 · 2019: 13 · 2018: 2
- FWCI
- 7.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Thyroid (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (P30CA016672)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Keywords
- immune checkpoint inhibitors, thyrotoxicosis, hypothyroidism, ipilimumab, nivolumab, pembrolizumab, levothyroxine, cancer immunotherapy adverse events, natural history (disease), melanoma, renal cell carcinoma, lung cancer, bladder cancer, colon cancer, endocrinology referral, treatment discontinuation
- MeSH terms
- Antineoplastic Agents, Immunological, Ipilimumab, Nivolumab, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Thyroid Function Tests, Thyroiditis, Autoimmune, Thyrotoxicosis, Young Adult
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