ECE2021 Audio Eposter Presentations Late Breaking (114 abstracts)
Management of thyrotoxicosis induced by PD1 or PD-L1 blockade
Alessandro Brancatella , Isabella Lupi , Nicola Viola , Daniele Sgrò , Lucia Montanelli , Chiara Sardella , Eleonora Molinaro , Paolo Piaggi , Rossella Elisei , Claudio Marcocci , Ferruccio Santini & Francesco Latrofa
University of Pisa, Pisa, Italy
Background
Thyrotoxicosis is a common immune-related adverse event in patients treated with PD1 or PD-L1 blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy is missing, as are data on response to treatment and follow-up. Aim of the study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and informing management.
Methods
We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis upon PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, scintigraphy, and longitudinal thyroid function tests.
Results
Five patients had normal scintigraphic uptake (Sci+), no serum antibodies against the TSH 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 = 0.04). Among Sci- subjects, a larger thyroid volume was associated to a longer time to remission (P <0.05). Methimazole (MMI) was effective only in Sci+ subjects (P<0.05).
Conclusion
Administration of PD1 or PD-L1 blocking antibodies may induce two 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 hypo- or euthyroidism. Thyroid scintigraphy and ultrasound help differentiating and managing these two forms of iatrogenic thyrotoxicosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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