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Management of Thyrotoxicosis Induced by PD1 or PD-L1 Blockade.
Brancatella, Alessandro; Lupi, Isabella; Montanelli, Lucia; Ricci, Debora; Viola, Nicola; Sgrò, Daniele; Antonangeli, Lucia; Sardella, Chiara; Brogioni, Sandra; Piaggi, Paolo; Molinaro, Eleonora; Bianchi, Francesca; Aragona, Michele; Antonuzzo, Andrea; Sbrana, Andrea; Lucchesi, Maurizio; Chella, Antonio; Falcone, Alfredo; Del Prato, Stefano; Elisei, Rossella; Marcocci, Claudio; Caturegli, Patrizio; Santini, Ferruccio; Latrofa, Francesco.
Afiliação
  • Brancatella A; Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy.
  • Lupi I; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Montanelli L; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Ricci D; Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy.
  • Viola N; Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy.
  • Sgrò D; Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy.
  • Antonangeli L; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Sardella C; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Brogioni S; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Piaggi P; Department of Information Engineering, University of Pisa, Pisa 56126, Italy.
  • Molinaro E; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Bianchi F; Nuclear Medicine Unit, Azienda Ospedaliero-Unuversitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Aragona M; Metabolic Diseases and Diabetes Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Antonuzzo A; Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56126, Italy.
  • Sbrana A; Oncology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa 56126, Italy.
  • Lucchesi M; Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Chella A; Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy.
  • Falcone A; Oncology Unit, Azienda Ospedaliero-Univeritaria Pisana and Department of Translational Research and New Technologies in Medicine abd Surgery, University Hospital of Pisa, Pisa 56126, Italy.
  • Del Prato S; Metabolic Diseases and Diabetes Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy.
  • Elisei R; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy.
  • Marcocci C; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy.
  • Caturegli P; Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
  • Santini F; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy.
  • Latrofa F; Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana and Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa 56124, Italy.
J Endocr Soc ; 5(9): bvab093, 2021 Sep 01.
Article em En | MEDLINE | ID: mdl-34337277
CONTEXT: Thyrotoxicosis is a common immune-related adverse event in patients treated with programmed cell death protein-1 (PD1) or programmed cell death protein ligand-1 (PD-L1) blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy, is lacking, as are data on response to treatment and follow-up. OBJECTIVE: The aim of this study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and treatment. METHODS: We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis on PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, 99mtechnecium scintiscan, and longitudinal thyroid function tests. RESULTS: Five patients had normal or increased scintigraphic uptake (Sci+), no serum antibodies against the thyrotropin receptor, and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci-) and experienced destructive thyrotoxicosis followed by hypothyroidism (N = 9) or euthyroidism (N = 6). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P = .04). Among Sci- individuals, a larger thyroid volume was associated with a longer time to remission (P < .05). Methimazole (MMI) was effective only in Sci+ individuals (P < .05). CONCLUSION: Administration of PD1- or PD-L1-blocking antibodies may induce 2 different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI, and a type 2, characterized by destructive and transient thyrotoxicosis that evolves to hypothyroidism or euthyroidism. Thyroid scintigraphy and ultrasound help in differentiating and managing these 2 forms of iatrogenic thyrotoxicosis.
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Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Observational_studies / Risk_factors_studies Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Observational_studies / Risk_factors_studies Idioma: En Ano de publicação: 2021 Tipo de documento: Article