Shibutani Yuma, Kawanobe Atsushi, Suzuki Shinya, Imaoka Takuro, Tajiri Kazuko
Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan.
J Immunother. 2025 Jun 1;48(5):183-188. doi: 10.1097/CJI.0000000000000555. Epub 2025 Mar 25.
Immune checkpoint inhibitor (ICI)-induced thyroid dysfunction is the most frequent endocrine immune-related adverse event (irAE). Thyroid hormones have various effects on the cardiovascular system; however, the impact of thyroid irAEs on the development of cardiovascular diseases is not fully understood. This retrospective study included 94 patients who received ICIs and had thyroid function and troponin T levels, markers of cardiac damage, measured at the National Cancer Center Hospital East between January 2017 and July 2022. Of the 94 patients, 36 (38%) showed elevated troponin levels after ICI treatment during the follow-up period. The median observation period was 249 days (interquartile range, 124-502 d). Thyroid irAEs [hypothyroidism (n=13) and hyperthyroidism (n=3)] associations were found in 16 (44%) of these 36 patients. None of the patients developed overt cardiovascular disease or died of heart disease, regardless of whether they experienced thyroid irAEs. The troponin levels increased with increasing thyroid stimulating hormone (TSH) levels. In particular, troponin levels were significantly elevated in patients with TSH >20 μIU/mL after ICI treatment ( P =0.009). In conclusion, thyroid irAEs may cause cardiac damage indicated by elevated troponin levels, necessitating special attention, particularly in cases of hypothyroidism where TSH exceeds 20 μIU/mL. Therefore, it is important to monitor cardiac markers along with thyroid function after ICI treatment.
免疫检查点抑制剂（ICI）诱导的甲状腺功能障碍是最常见的内分泌免疫相关不良事件（irAE）。甲状腺激素对心血管系统有多种影响；然而，甲状腺irAE对心血管疾病发展的影响尚未完全明确。这项回顾性研究纳入了94例接受ICI治疗的患者，这些患者于2017年1月至2022年7月在国立癌症中心东医院测量了甲状腺功能和肌钙蛋白T水平（心脏损伤标志物）。在这94例患者中，36例（38%）在随访期间ICI治疗后肌钙蛋白水平升高。中位观察期为249天（四分位间距，124 - 502天）。在这36例患者中的16例（44%）发现了甲状腺irAE（甲状腺功能减退，n = 13；甲状腺功能亢进，n = 3）。无论患者是否经历甲状腺irAE，均未发生明显的心血管疾病或死于心脏病。肌钙蛋白水平随促甲状腺激素（TSH）水平升高而增加。特别是，ICI治疗后TSH>20 μIU/mL的患者肌钙蛋白水平显著升高（P = 0.009）。总之，甲状腺irAE可能导致肌钙蛋白水平升高所表明的心脏损伤，需要特别关注，尤其是在TSH超过20 μIU/mL的甲状腺功能减退病例中。因此，在ICI治疗后监测心脏标志物以及甲状腺功能很重要。
