Velez Maria A, Kang Elliot S, Thompson Chester A, Lind-Lebuffe Jackson, Shen Collin, Park Seung Jun, Han Andy, Gower Arjan, Li Daniel, Rochigneux Philippe, Grogan Tristan R, Elashoff David A, Garon Edward B, Lisberg Aaron
Department of Medicine, Division of Hematology and Oncology, University of California, Los Angeles, Los Angeles, CA.
Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France.
JCO Oncol Pract. 2025 Jun 2:OP2500027. doi: 10.1200/OP-25-00027.
Immune checkpoint inhibitor (ICI)-induced thyroid dysfunction is a common endocrine immune-related adverse event. Although rates during therapy are well documented, data on post-treatment thyroid dysfunction are limited. We hypothesized that post-ICI thyroid dysfunction is under-recognized because of inadequate surveillance.
A retrospective analysis of 3,626 patients treated with ICIs for various malignancies within a single health system was conducted. Clinically acted-upon thyroid dysfunction (diagnosis or thyroid-directed medication) was evaluated before, during, and after ICI therapy, alongside rates of thyroid laboratory surveillance.
Clinically acted-upon thyroid dysfunction occurred in 8.1% (294/3,626) during treatment and 4.4% (159/3,626) after treatment. Among the 1,170 patients with post-ICI thyroid laboratory results and no prior dysfunction, 11.6% (136/1,170) developed post-ICI thyroid dysfunction. However, 48.6%% (1,764/3,626) had no post-ICI thyroid laboratory results. Thirty percent of patients with abnormal thyroid stimulating hormone (TSH) values and no clinically acted-upon thyroid dysfunction before therapy discontinuation subsequently developed clinically acted-upon thyroid dysfunction, and the rate of post-ICI clinically acted-upon thyroid dysfunction was higher in patients who received 9 or less months of ICI therapy.
Post-ICI thyroid dysfunction is frequent, with 11.6% of monitored patients being affected, and patients with abnormal TSH before ICI discontinuation and those who received treatment for 9 months or less may benefit from more stringent post-ICI surveillance.
免疫检查点抑制剂（ICI）诱导的甲状腺功能障碍是一种常见的内分泌免疫相关不良事件。虽然治疗期间的发生率已有充分记录，但关于治疗后甲状腺功能障碍的数据有限。我们推测，由于监测不足，ICI治疗后甲状腺功能障碍未得到充分认识。
对单一医疗系统内接受ICI治疗各种恶性肿瘤的3626例患者进行回顾性分析。在ICI治疗前、治疗期间和治疗后，评估临床确诊的甲状腺功能障碍（诊断或甲状腺定向用药）以及甲状腺实验室监测率。
治疗期间临床确诊的甲状腺功能障碍发生率为8.1%（294/3626），治疗后为4.4%（159/3626）。在1170例治疗后有甲状腺实验室检查结果且既往无功能障碍的患者中，11.6%（136/1170）发生了治疗后甲状腺功能障碍。然而，48.6%（1764/3626）的患者没有治疗后甲状腺实验室检查结果。在治疗停药前促甲状腺激素（TSH）值异常但无临床确诊甲状腺功能障碍的患者中，30%随后出现了临床确诊的甲状腺功能障碍，接受ICI治疗9个月或更短时间的患者治疗后临床确诊甲状腺功能障碍的发生率更高。
ICI治疗后甲状腺功能障碍很常见，11.6%的受监测患者受到影响，ICI停药前TSH异常的患者以及接受治疗9个月或更短时间的患者可能受益于更严格的ICI治疗后监测。
