Oki Tatsuya, Inoue Akitoshi, Nagatani Yukihiro, Oki Maya, Watanabe Yoshiyuki
Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan.
J Clin Imaging Sci. 2022 May 2;12:22. doi: 10.25259/JCIS_194_2021. eCollection 2022.
The thyroid gland is most frequently involved in immune-related adverse events (irAEs) by nivolumab. We reviewed the thyroid function and thyroid gland volume and volume change ratio between baseline and follow-up CT (volume follow-up/volume baseline) in 24 patients treated with nivolumab for lung cancer and renal cell carcinoma. Among them, four (16.7%) demonstrated nivolumab-induced thyroid dysfunction that shows either hypothyroidism or hyperthyroidism. Three and one cases were treated with nivolumab for lung cancer and renal cell carcinoma, respectively. Two patients with hypothyroidism (cases 1 and 2) showed reduced thyroid volume (volume change ratio: 0.80 and 0.84) on computed tomography (CT) images. Besides, remarkably diminished CT attenuation of the thyroid gland was observed in a patient with hypothyroidism (case 2). One of the two patients with hyperthyroidism showed increased thyroid volume (volume change ratio: 1.32) (case 3), whereas no difference in the thyroid gland volume was observed between the previous and follow-up CT in another patient with hyperthyroidism (case 4). Thyroid volume change ratio >0.1 was observed even in 6 of 20 (30%) patients without thyroid dysfunction. Considering the wide use of nivolumab in cancer treatment, radiologists should be aware that changes in the thyroid volume and attenuation on CT are associated with thyroid dysfunction caused by nivolumab, as well as thyroid volume may change even in patients with normal thyroid function during nivolumab therapy.
甲状腺最常受累于纳武利尤单抗引起的免疫相关不良事件（irAEs）。我们回顾了24例接受纳武利尤单抗治疗的肺癌和肾细胞癌患者的甲状腺功能、甲状腺体积以及基线CT与随访CT之间的体积变化率（体积随访/体积基线）。其中，4例（16.7%）出现了纳武利尤单抗诱导的甲状腺功能障碍，表现为甲状腺功能减退或甲状腺功能亢进。分别有3例和1例接受纳武利尤单抗治疗的患者为肺癌和肾细胞癌。2例甲状腺功能减退患者（病例1和病例2）在计算机断层扫描（CT）图像上显示甲状腺体积减小（体积变化率：0.80和0.84）。此外，1例甲状腺功能减退患者（病例2）的甲状腺CT衰减明显降低。2例甲状腺功能亢进患者中的1例甲状腺体积增大（体积变化率：1.32）（病例3），而另1例甲状腺功能亢进患者（病例4）的甲状腺体积在之前和随访CT之间未观察到差异。即使在20例（30%）无甲状腺功能障碍的患者中，也有6例观察到甲状腺体积变化率>0.1。考虑到纳武利尤单抗在癌症治疗中的广泛应用，放射科医生应意识到CT上甲状腺体积和衰减的变化与纳武利尤单抗引起的甲状腺功能障碍有关，并且在纳武利尤单抗治疗期间，即使甲状腺功能正常的患者甲状腺体积也可能发生变化。
