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Theiler-Schwetz, V; Trummer, C; Richtig, E; Richtig, G; Pilz, S.
Thyroid disorders during immune checkpoint inhibitor therapy.
AUST J CLIN ENDOCR M. 2020; Doi: 10.1007/s41969-020-00111-y [OPEN ACCESS]
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Leading authors Med Uni Graz: Theiler-Schwetz Verena
Co-authors Med Uni Graz: Pilz Stefan; Richtig Erika; Richtig Georg; Trummer Christian
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Abstract:: Thyroid disorders are the most common forms of endocrine adverse events under immune checkpoint inhibitor treatment. The risk is higher with regard to anti-programmed cell death 1 (anti-PD-1) antibody treatment as compared to anti-cytotoxic-T-lymphocyte-antigen-4(CTLA-4)-treatment and rises with the use of combination therapies. The underlying mechanism seems to be a destructive thyroiditis similar to postpartum thyroiditis leading to a transient phase of hyperthyroidism followed by hypothyroidism or euthyroidism. Hypothyroidism without a preceding phase of hyperthyroidism is also possible. The therapeutic strategy includes monitoring with symptomatic treatment with beta-blockers, if necessary. Glucocorticoids or antithyroid drugs are not useful. Levothyroxine treatment should be commenced in symptomatic hypothyroidism with a TSH (thyroid-stimulating hormone) of 5-10muU/mL or a TSH of >10-U/mL independent of the clinical presentation. Due to its oligo- or asymptomatic clinical presentation, regular screening for thyroid disorders and hypophysitis starting prior to initiation of immune therapy and monthly thereafter should be carried out including TSH, free triiodothyronine (fT3), free thyroxine (fT4), cortisol and adrenocorticotropic hormone (ACTH). Screening intervals can be widened after that. The development of thyroid disorders should usually not lead to interruption of immune therapy, being mainly transient, easy to treat and mild.
Find related publications in this database (Keywords): Immune checkpoint inhibitors; Hyperthyroidism; Hypothyroidism; Destructive thyroiditis