Optimal Thyroid Hormone Replacement Dose in Immune Checkpoint Inhibitor-Associated Hypothyroidism Is Distinct from Hashimoto's Thyroiditis

Mosaferi, Tina; Tsai, Karen; Sovich, Samantha; Wilhalme, Holly; Kathuria‐Prakash, Nikhita; Smooke-Praw, Stephanie; Drakaki, Alexandra; Angell, Trevor E.; Lechner, Melissa G.

doi:10.1089/thy.2021.0685

Cited by 19 publications

(8 citation statements)

References 24 publications

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“…Restoring thyroid function is the aim of post-thyroidectomy replacement treatment, which aims to prevent over- or under-substitution by starting with the recommended dose of L-T4 seven days following the operation [ 14 ]. A dosage of L-T4 replacement that results in normal or slightly elevated serum T4 concentration and TSH concentration returning to a normal value is by definition the ideal dose [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy

Mansy,

Elsenosy,

Hassan

et al. 2023

Cureus

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Background Thyroid hormone replacement (THR) in athyreotic patients post-thyroidectomy due to thyroid cancer might seem like a straightforward clinical issue to address. To investigate the impact of THR on enhancing thyroid-stimulating hormone (TSH) levels, we conducted a clinical audit, tailoring the dosage based on patient weight and aligning with the standards outlined by the National Institute for Health and Care Excellence and the American Thyroid Association guidelines. Methodology This retrospective and prospective audit analyzed outpatient clinic records for hormone replacement therapy (HRT) post-total thyroidectomy. Retrospective data from March to May 2022 were collected, followed by prospective data after interventions adjusting HRT based on patient weight to digitize clinic notes. The second phase involved changes for 20 scheduled thyroidectomy patients among the total 37 included in the study. Results The thyroid profiles of both groups in the initial and subsequent cycles, treated with adjusted doses of THR, exhibited normal levels of thyroid hormones and calcium. No substantial differences were observed between the groups. On multivariate logistic regression analysis, we found that older age, male sex, body mass index, and preoperative TSH level were the only significant predictors of the need for hormonal therapy. Conclusions Optimal dose of THR after total thyroidectomy had a positive effect on TSH levels in hypothyroidism patients. Hence, THR should be prescribed according to patient weight based on standards and guidelines.

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Section: Discussionmentioning

confidence: 99%

A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy

Mansy,

Elsenosy,

Hassan

et al. 2023

Cureus

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“…5,16 Interestingly, a recent analysis of thyroid hormone dose requirements in patients with a history of ICPi-thyroiditis found little difference from controls who had had thyroid surgery, consistent with a near-complete destruction of the thyroid gland. 18 Therefore, early initiation of thyroid hormone replacement in the second phase can avoid the development of symptomatic hypothyroidism. The American Thyroid Association has recognized that even in those with cardiac disease, rapid replacement of thyroid hormone can be done safely if the onset of hypothyroidism has been acute.…”

Section: Thyroid Dysfunctionmentioning

confidence: 99%

Endocrine Dysfunction From Immune Checkpoint Inhibitors: Pearls and Pitfalls in Evaluation and Management

Kotwal

Perlman

Goldner

et al. 2023

JCO Oncology Practice

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Immune checkpoint inhibitors (ICPis) have proven extremely efficacious in cancer therapy but also lead to a plethora of immune-related adverse events (irAEs). The endocrine irAEs are not only quite common but also may pose a challenge to the clinician while managing a patient with cancer treated with ICPis. The clinical features of endocrine dysfunction are usually nonspecific and may overlap with concurrent illnesses, underlying the importance of accurate hormone testing and efforts toward case-finding. The management of endocrine irAEs is unique in the focus being on hormone replacement rather than curtailing the autoimmune process. Although the management of thyroid irAEs appears straightforward, adrenal insufficiency and insulin-dependent diabetes can be life-threatening if not promptly recognized and treated. This clinical review synthesizes the studies to provide pearls and pitfalls in the evaluation and management of endocrine irAEs with specific reference to guidelines from oncologic societies.

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“…Alternatively, TSH and FT4 can be repeated after 4-6 weeks and if hypothyroidism persists, treatment can be initiated at that point ( 25 ). Thyroxine doses are typically higher for patients with ICI-mediated hypothyroidism than for Hashimoto’s thyroiditis, suggesting that gland destruction is complete in most cases of ICI-mediated thyroiditis whereas it is slowly progressive with some residual production of endogenous thyroid hormone in patients with Hashimoto’s thyroiditis ( 26 ). A simplified algorithm for the classification and management of thyroid irAEs is presented in Figure 1 .…”

Section: Thyroid Immune Related Adverse Eventsmentioning

confidence: 99%

Immune Related Adverse Events of the Thyroid – A Narrative Review

et al. 2022

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Immune checkpoints are small molecules present on the cell surface of T-lymphocytes. They maintain self-tolerance and regulate the amplitude and duration of T-cell responses. Antagonism of immune checkpoints with monoclonal antibodies (immune checkpoint inhibitors) is a rapidly evolving field of anti-cancer immunotherapy and has become standard of care in management of many cancer subtypes. Immune checkpoint inhibition is an effective cancer treatment but can precipitate immune related adverse events (irAEs). Thyroid dysfunction is the most common endocrine irAE and can occur in up to 40% of treated patients. Both thyrotoxicosis and hypothyroidism occur. The clinical presentation and demographic associations of thyrotoxicosis compared to hypothyroidism suggest unique entities with different etiologies. Thyroid irAEs, particularly overt thyrotoxicosis, are associated with increased immune toxicity in other organ systems, but also with longer progression-free and overall survival. Polygenic risk scores using susceptibility loci associated with autoimmune thyroiditis predict development of checkpoint inhibitor associated irAEs, suggesting potentially shared mechanisms underpinning their development. Our review will provide an up-to-date summary of knowledge in the field of thyroid irAEs. Major focus will be directed toward pathogenesis (including genetic factors shared with autoimmune thyroid disease), demographic associations, clinical presentation and course, treatment, and the relationship with cancer outcomes.

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Optimal Thyroid Hormone Replacement Dose in Immune Checkpoint Inhibitor-Associated Hypothyroidism Is Distinct from Hashimoto's Thyroiditis

Cited by 19 publications

References 24 publications

A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy

A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy

Endocrine Dysfunction From Immune Checkpoint Inhibitors: Pearls and Pitfalls in Evaluation and Management

Immune Related Adverse Events of the Thyroid – A Narrative Review

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