Risk of thyroid dysfunction in PD-1 blockade is stratified by the pattern of TgAb and TPOAb positivity at baseline.
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CONTEXT: Positive antithyroglobulin (TgAb) and/or antithyroid peroxidase antibodies (TPOAb) at baseline indicate a high risk of thyroid immune-related adverse events (irAEs) induced by antiprogrammed cell death-1 antibodies (anti-PD-1-Ab). However, whether the positivity patterns of both antibodies are associated with the risk of thyroid irAEs is unknown. OBJECTIVE: The aim of the present study was to clarify the association of the pattern of TgAb and TPOAb positivity at baseline with the risk of thyroid irAEs induced by anti-PD-1-Ab. METHODS: Patients (n = 516) were evaluated for TgAb and TPOAb at baseline and prospectively for thyroid function every 6 weeks for 24 weeks after initiating anti-PD-1-Ab. RESULTS: Fifty-one (9.9%) patients developed thyroid irAEs (thyrotoxicosis in 34, hypothyroidism without prior thyrotoxicosis in 17). Twenty-five patients subsequently developed hypothyroidism following thyrotoxicosis. The cumulative incidence of thyroid irAEs differed among 4 groups classified by the presence of TgAb/TPOAb at baseline (group 1: TgAb-(-)/TPOAb-(-), 4.6% [19/415]; group 2: TgAb-(-)/TPOAb-(+), 15.8% [9/57]; group 3: TgAb-(+)/TPOAb-(-), 42.1% [8/19]; group 4: TgAb-(+)/TPOAb-(+), 60.0% [15/25]) as follows: groups 1 vs 2-4 (P ≤ .001) and groups 2 vs 3 (P = .008) and 4 (P < .001). There were different incidences of thyrotoxicosis (groups 1-4, 3.1%, 5.3%, 31.6%, 48.0%, respectively; P < .001) in groups 1 vs 3 and 4, and groups 2 vs 3 and 4, and of hypothyroidism (groups 1-4: 2.9%, 15.8%, 31.6%, 60.0%, respectively; P < .001) in groups 1 vs 2 to 4, and groups 2 vs 4. CONCLUSION: The risk of thyroid irAEs was affected by the pattern of TgAb and TPOAb positivity at baseline; there were high risks of thyrotoxicosis in patients with TgAb-(+) and of hypothyroidism in patients with TgAb-(+) and those with TPOAb-(+).
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Drug-induced hypothyroidism is caused by medications such as amiodarone, lithium, and immune checkpoint inhibitors.
“Drug-induced hypothyroidism is caused by medications such as amiodarone, lithium, and immune checkpoint inhibitors ( Figure 1 ). 28,29”
From Hypothyroidism: A Review (2025) · cites this paper as [29]
The Abstract states that anti-PD-1 immune checkpoint inhibitors can induce thyroid dysfunction, including hypothyroidism. The paper does not address amiodarone or lithium, so it supports only the immune-checkpoint-inhibitor example in the citing sentence. (LLM, conf=0.88)
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References 42 · Cited by 35
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- Robert C, Long GV, Brady B, et al. Nivolumab in previously un- treated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320-330.
- e1062 The Journal of Clinical Endocrinology & Metabolism, 2023, Vol. 108, No. 10
- Authors
- Zhou, X., Iwama, S., Kobayashi, T., Ando, M., & Arima, H.
- Affiliations
- Nagoya University (JP)
- Nagoya University Hospital (JP)
- Corresponding author
- Iwama, Shintaro
- Arima, Hiroshi
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2023-04-21
- Volume
- 108
- Issue
- 10
- Pages
- e1056-e1062
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W4366605863
- Cited by
- 35
- References
- 42
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 11 · 2023: 1
- FWCI
- 4.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Funders
- Japan Society for the Promotion of Science (21K16352, 23K24386)
- 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
- thyroid dysfunction, immune-related adverse events, anti-PD-1 therapy, thyroglobulin antibodies, thyroid peroxidase antibodies, thyrotoxicosis, hypothyroidism, cancer immunotherapy, risk stratification, thyroid function monitoring, anti-PD-1, PD-L1 inhibitors
- MeSH terms
- Autoantibodies, Humans, Hypothyroidism, Iodide Peroxidase, Thyroglobulin, Thyroid Diseases, Thyrotoxicosis
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