Zheng Xiaoya, Xiao Heng, Long Jian, Wei Qiang, Liu Liping, Zan Liping, Ren Wei
Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Endocr Connect. 2022 May 23;11(5):e220065. doi: 10.1530/EC-22-0065.
Programmed cell death protein-1 (PD-1) inhibitors are widely used for the treatment of hepatocellular carcinoma (HCC). Thyroid dysfunction is common in patients treated with this therapy, although the dynamic changes in thyroid function and sonographic features remain unclear.
We analyzed 38 patients with HCC who received anti-PD-1 therapy at our hospital. Demographic, clinical, laboratory, and ultrasound data were extracted from electronic medical records. The grading of thyroid nodules was based on the American College of Radiology Thyroid Imaging Reporting and Data System classification. Statistical analyses were performed using GraphPad Prism 5.0.
Fifteen patients (40%) had hypothyroidism, among which six had hypothyroidism at baseline, three had overt hypothyroidism, and six had subclinical hypothyroidism after anti-PD1 therapy. The proportion of patients with euthyroid function and thyroid antibody positivity was significantly lower than that of patients with thyroid dysfunction (10% vs 39%, P < 0.05). Nine patients (24%) had irregular echo patterns on sonographic imaging, six of whom had irregular echo patterns present during the treatment, but only one had them persist until the end of treatment. At baseline, the classification of most thyroid nodules was grade 3, with a significant increase in grade 4A and 4B classifications during treatment, though most nodules remained grade 3 at the end of treatment. There were no significant differences in survival rates between the euthyroid and thyroid dysfunction groups.
Anti-PD-1 therapy-induced thyroid dysfunction was accompanied by changes in thyroid function, antibodies, and ultrasonography. Therefore, in patients receiving anti-PD-1 therapy, close, dynamic monitoring of thyroid function, antibodies, and ultrasonographic characteristics is necessary.
程序性细胞死亡蛋白1（PD-1）抑制剂被广泛用于治疗肝细胞癌（HCC）。甲状腺功能障碍在接受该疗法的患者中很常见，尽管甲状腺功能的动态变化和超声特征仍不清楚。
我们分析了我院38例接受抗PD-1治疗的HCC患者。从电子病历中提取人口统计学、临床、实验室和超声数据。甲状腺结节的分级基于美国放射学会甲状腺影像报告和数据系统分类。使用GraphPad Prism 5.0进行统计分析。
15例患者（40%）出现甲状腺功能减退，其中6例在基线时即有甲状腺功能减退，3例为显性甲状腺功能减退，6例在抗PD-1治疗后出现亚临床甲状腺功能减退。甲状腺功能正常且甲状腺抗体阳性的患者比例显著低于甲状腺功能障碍患者（10%对39%，P<0.05）。9例患者（24%）超声成像显示回声模式不规则，其中6例在治疗期间出现不规则回声模式，但只有1例持续到治疗结束。基线时，大多数甲状腺结节分类为3级，治疗期间4A和4B级分类显著增加，尽管大多数结节在治疗结束时仍为3级。甲状腺功能正常组和甲状腺功能障碍组的生存率无显著差异。
抗PD-1治疗引起的甲状腺功能障碍伴有甲状腺功能、抗体和超声检查的变化。因此，对于接受抗PD-1治疗的患者，有必要密切、动态地监测甲状腺功能、抗体和超声特征。
