Table 1 Immunotherapy-thyroid disease case reports during 2022–2023
From: Immunotherapy-induced thyroid dysfunction: an updated review
Study name | Age | Sex | Cancer type | Drug name | Adverse events | Lab findings | Recommendation | Others |
|---|---|---|---|---|---|---|---|---|
Marinides et al. (2022) [30] | 76 | Not mentioned | Not mentioned | Teprotumumab | Graves’ disease | MRI brain showed CAA with subacute bleeds, negative CSF studies, negative paraneoplastic panel | Contraindication of IGF-1R inhibitors in the presence of underlying cerebrovascular disease | Rapid cognitive decline, response to immune-modulatory treatments |
Vilaca et al. (2022) [31] | 62 | Male | Metastatic NSCLC | Immunotherapy | Graves’ disease | Current smoker, EGFR, and ALK wild types | Caution when interpreting results due to single patient | Long-lasting response, no immune-related adverse events |
Duminuco et al. (2022) [32] | N/A | N/A | N/A | Nivolumab | Thyroid disorder | N/A | Temporarily ineligible for transplantation | Adverse effects involving multiple organs |
Najjar & Yu (2022) [33] | N/A | N/A | Various | ICIs (including nivolumab and ipilimumab) | Immune-mediated endocrinopathies | Varies depending on the type of endocrinopathy (thyroid and pituitary gland involvement common) | A high index of clinical suspicion and a multidisciplinary team approach with endocrinologists | Case-based clinical review |
Kataoka et al. (2022) [34] | 72 | Female | Non-small cell lung cancer (NSCLC) | Nivolumab and ipilimumab | Thyroid storm | Positive for antithyroid antibodies, prominent hyperthyroidism with gastrointestinal symptoms and signs of heart failure | Evaluate thyroid function and symptoms of suspected thyroid storm within 3 weeks from the initiation of therapy when combination therapy is administered in patients with NSCLC positive for antithyroid antibodies | The patient had no history of thyroid disease |
De Filette et al. (2022) [35] | 63 | Female | Non-small cell lung carcinoma | Durvalumab | Thyrotoxicosis followed by hypothyroidism | HLA-DR4 and DR13 | Proactive monitoring of thyroid hormone levels | Identification of biomarkers for better patient selection and understanding of mechanisms |
Bao & Jiang (2022) [36] | 59 | Female | Non-small cell lung cancer | Pembrolizumab | Immune-induced autoimmune thyroiditis | Continuously monitor thyroid function and provide thyroxine replacement therapy | Carefully monitor patients with underlying thyroiditis before deciding on immunotherapy treatment | It discusses features and general mechanisms of immune-related endocrine toxicity |
Bao & Jiang (2022) (the same patient) [36] | 59 | Female | Non-small cell lung cancer | Pembrolizumab | Immune-induced autoimmune diabetes, diabetic ketoacidosis | Discontinue immunotherapy, diagnosed with insulin-dependent diabetes mellitus | Carefully monitor patients for signs of autoimmune diabetes | |
Chen et al. (2022) [37], tw cases | 65/52 | Male/female | Relapsed refractory B-cell lymphoma | CAR-T-cell therapy | Hashimoto’s thyroiditis | N/A | Further investigation of the mechanisms of CAR-T therapy on the thyroid tissue | A rare adverse effect, complete remission achieved at 1 and 3 months |
Braga et al. (2022), case 1 [38] | 44 | Female | Metastatic melanoma | Nivolumab | Acute thyroiditis, hypothyroidism | TSH: 310 µUI/mL, FT4, and FT3 under the detection limit, positive for anti-TG 471 UI/mL and nti-TPO 172 UI/mL | Continue nivolumab under continuous levothyroxine supplementation | Acute thyroiditis with suppression of thyroid hormone synthesis |
Braga et al. (2022), case 2 [38] | 72 | Female | Lung adenocarcinoma | Pembrolizumab | Diabetic ketoacidosis, autoimmune thyroiditis, hypothyroidism | Hyperglycemia (> 658 mg/dL), ketoacidosis (pH < 7.0, HCO3 — 5.2 mmol/L), TSH: 11.2 µUI/mL, FT4: 0.569 ng/dL, TT4: 2.97 µg/dL, FT3: 0.666 pg/mL, TT3: 32.77 ng/dL, positive for anti-TPO 319 UI/mL | Admit to the intensive care unit | Life-threatening multi-organic compromise with neurological repercussions |