Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2019) 63 P765 | DOI: 10.1530/endoabs.63.P765

Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy.

Context: Monoclonal antibodies to Immune Check Point inhibitors (ICPis) are powerful anti-cancer drugs. They trigger the immune system against cancer cells, blocking inhibitory signals of T-Cells. However, ICPi therapy can also stimulate autoimmune reactions, inducing the so-called immune-related adverse events (irAEs). Endocrinopathies are common iRAEs and thyroid disfunction is the most common endocrinopathy during ICP therapy. We report three cases of thyroid disfunction during Nivolumab (Anti-PD1) therapy.

Case 1: A 65 year old male that undergoing Nivolumab treatment for metastatic non-small cell lung cancer. At baseline, FT4, FT3 and TSH were in the normal range, while thyroid autoantibodies (TgAb and TPOAb) were slightly positive. Neck ultrasonography showed a hypoechoic normal size thyroid with no nodules. Eight weeks later, thyroid function test demonstrated an overt hyperthyroidism. TRAb were undetectable and thyroid scintigraphy showed low uptake. During follow-up, FT4, FT3 and TSH normalized spontaneously within 3 months and remained in the normal range during Nivolumab treatment.

Case 2: A 67 year old female came to our observation because of recent onset of fatigue and hair loss. She was administered the third infusion of Nivolumab because of a metastatic non-smal cell lung cancer. Thyroid function tests revealed an overt hypothyroidism (FT4: 0.5 ng/dl (normal range 0.7–1.7); TSH: 38 mcUI/ml (normal range 0.4–4)). At baseline, thyroid function test was in the normal range and thyroid autoantibodies were highly positive. Neck ultrasonography showed a markedly hypoechoic thyroid of small size. Levothyroixe treatment was started. Euthyroidism was restored in 2 months with improvement of symptoms.

Case 3: A 51 year old male came to observation because of palpitations, heat intolerance and insomnia. He was at the sixth infusion of Nivolumab for a metastatic melanoma. Before the immune therapy thyroid function tests were in the normal range; autoantibodies were undetectable. An increased heart rate and sweaty skin were found at physical examination. Thyroid function tests showed an overt hyperthyroidism (FT4: 2.28 ng/dl; FT3: 7.82 pg/ml (normal range 2.7–5.7) TSH: < 0.004 mcUI/ml). Thyroid autoantibodies remained undetectable. Neck ultrasonography showed an enlarged hypoechoic thyroid with a hypervascular pattern. Tc99 thyroid scintigraphy showed an increased uptake. Methymazole therapy was started and a normal thyroid function was restored within a few days.

Conclusions: Thyroid dysfunction during immunotherapy is a common irAE that may have variable presentation and impact negatively on patient’s general conditions. When thyroid dysfunction is managed properly, immunotherapy does not usually need to be discontinued.

Volume 63

21st European Congress of Endocrinology

Lyon, France
18 May 2019 - 21 May 2019

European Society of Endocrinology 

Browse other volumes

Article tools

My recent searches

No recent searches.