Graves’ disease following immune reconstitution or immunomodulatory treatment: should we manage it any differently?
Abstract
Graves' disease and other disorders of thyroid function may occur following treatment with novel anticancer agents or during periods of lymphocyte recovery after lymphopenia. There are three main settings for such lymphocyte reconstitution: recovery after a bone marrow or haematopoietic stem cell transplant, alemtuzumab treatment and the use of highly active antiretroviral therapy (HAART) for human immunodeficiency virus infection. The available evidence suggests that Graves' disease behaves as normal in most of these cases and should be treated conventionally, but it may follow a more favourable course in those receiving alemtuzumab or HAART. As spontaneous or drug-induced remission may be more likely in these two settings, first-line treatment should usually consist of an antithyroid drug.
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Post-IRT thyroid dysfunction might follow an atypical fluctuating course.
“Post-IRT TD might follow an atypical fluctuating course, necessitating appropriate diagnostic and therapeutic management [69].”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [69]
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Alemtuzumab-Induced Thyroid Dysfunction Exhibits Distinctive Clinical and Immunological Features
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“In contrast to the usually irreversible hypothyroidism of classical Hashimoto’s thyroiditis disease, a higher frequency of potential reversibility needs to be considered in hypothyroidism developing post-IRT, as a higher frequency of atypical autoimmune thyroid disease is reported [69].”
BackgroundEdmunds, M. R., Mellington, F., Ford, R. L., Torlinska, B., Manavi, K., & Boelaert, K. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3544 · Cited by 14 · see citing works
- Authors
- Weetman, A. P.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Weetman, Anthony P.
- ORCID
- Weetman, Anthony P.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2014-04-09
- Volume
- 80
- Issue
- 5
- Pages
- 629-632
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1969069960
- Cited by
- 46
- References
- 30
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 7 · 2017: 3 · 2016: 7 · 2015: 4 · 2014: 2
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- Graves' disease, immune reconstitution, immunomodulatory therapy, alemtuzumab, highly active antiretroviral therapy, HIV infection, hematopoietic stem cell transplantation, bone marrow transplantation, lymphopenia, drug-induced thyroid dysfunction, antithyroid drugs, drug-induced remission
- MeSH terms
- Alemtuzumab, Bone Marrow Cells, Endocrinology, Graves Disease, Humans, Immune System, Lymphocytes, Lymphopenia, Neoplasms, Remission Induction, Hematopoietic Stem Cell Transplantation, Antiretroviral Therapy, Highly Active, Antibodies, Monoclonal, Humanized
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