Patrizio Armando, Fallahi Poupak, Antonelli Alessandro, Ferrari Silvia Martina
Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Curr Pharm Des. 2023;29(4):295-299. doi: 10.2174/1381612828666220518151509.
Immune checkpoint inhibitors (ICI) foster T lymphocytes to fight cancer, but they can also trigger immune-related adverse events (irAE) in various organs, including thyroid dysfunction that can manifest itself in terms of both hyperthyroidism and hypothyroidism or subclinical disease.
Based on previous observations, this study evaluated the impact of oncological immunotherapy on the development of thyroid dysfunction in a cohort of patients treated with ICI at our institution.
We collected 10 cases of thyroid irAE that emerged from 24 cancer patients treated with immunotherapy, belonging to a cohort of 120 patients who were sent to our clinic by the Oncology Department of our institution, between December 2016 and March 2020.
From the analysis of the data, thyroid irAEs emerged after a median time of 9 weeks, and they occurred mainly in females. Regardless of the initial presentation (thyroiditis with thyrotoxicosis, hypothyroidism, or worsening of the previous subclinical hypothyroidism), later all patients developed persistent hypothyroidism which required hormone replacement therapy with levothyroxine. This finding was confirmed by a statistically significant increase in the median value of TSH (thyroid-stimulating hormone) between the pre-ICI treatment and subsequent phases and, for the first time, by a reduction in the median value of the thyroid volume estimated by neck ultrasound, a sign of destructive thyroiditis.
Our results confirm that patients undergoing immunotherapy should be monitored for potential thyroid dysfunction with biochemical assessments and changes in thyroid volume estimated by ultrasound could be helpful in the diagnostic work-up.
免疫检查点抑制剂（ICI）可促进T淋巴细胞对抗癌症，但也会在包括甲状腺功能障碍（可表现为甲状腺功能亢进、甲状腺功能减退或亚临床疾病）在内的各个器官引发免疫相关不良事件（irAE）。
基于以往观察，本研究评估了肿瘤免疫治疗对我院接受ICI治疗的一组患者甲状腺功能障碍发生情况的影响。
我们收集了24例接受免疫治疗的癌症患者中出现的10例甲状腺irAE病例，这些患者来自2016年12月至2020年3月间我院肿瘤科转诊至我科室的120例患者队列。
数据分析显示，甲状腺irAE在中位时间9周后出现，主要发生在女性患者中。无论初始表现如何（甲状腺毒症伴甲状腺炎、甲状腺功能减退或既往亚临床甲状腺功能减退加重），所有患者后来均发展为持续性甲状腺功能减退，需要用左甲状腺素进行激素替代治疗。ICI治疗前与后续阶段之间促甲状腺激素（TSH）中位值的统计学显著升高证实了这一发现，并且首次通过颈部超声估计的甲状腺体积中位值的降低得以证实，这是破坏性甲状腺炎的一个迹象。
我们的结果证实，接受免疫治疗的患者应通过生化评估监测潜在的甲状腺功能障碍，超声估计的甲状腺体积变化可能有助于诊断检查。
