Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features
Rationale. Immune Checkpoint Inhibitors (ICIs) are approved for some advanced neoplasms, increasing survival. ICIs block inhibitor receptors cytotoxic T lymphocyte antigen 4 (CTLA4) and programmed death-1 (PD-1) and trigger T cell-mediated immunity against tumor. Their action is accompanied by sever...
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Accademia Peloritana dei Pericolanti
2017-12-01
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doaj-b075d767588f4552aabf0931c162cc662020-11-25T00:54:45ZengAccademia Peloritana dei PericolantiAtti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche0365-02941828-65502017-12-01105210.6092/1828-6550/APMB.105.2.2017.A21345Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical featuresGiuseppe Giuffrida0Alfredo Campennì1Francesco Trimarchi2Rosaria M. Ruggeri3University of Messina, Department of Clinical and Experimental Medicine, Unit of EndocrinologyUniversity of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Nuclear MedicineAccademia Peloritana dei Pericolanti, MessinaUniversity of Messina, Department of Clinical and Experimental Medicine, Unit of EndocrinologyRationale. Immune Checkpoint Inhibitors (ICIs) are approved for some advanced neoplasms, increasing survival. ICIs block inhibitor receptors cytotoxic T lymphocyte antigen 4 (CTLA4) and programmed death-1 (PD-1) and trigger T cell-mediated immunity against tumor. Their action is accompanied by several immunity-related adverse events (IRAEs), also involving the endocrine system (pituitary, thyroid, adrenals). We report two different cases of thyrotoxicosis following administration of the anti-PD-1 nivolumab. Patients. Patient 1, M, 75 years-old, treated for non-small cell lung carcinoma (NSCLC) since September 2016, with euthyroid multinodular goiter. In January 2017 (12 weeks from baseline), he developed frank hyperthyroidism, with positive TSH-receptor antibodies (TRAb) and thyroperoxidase antibodies (TPOAb). A Tc99m thyroid scintiscan showed diffuse uptake and “cold” areas. After nivolumab withdrawal, treatment with metimazole (MMI) 5 mg per day was started and euthyroidism was resumed, so to restart the drug in May 2017. Patient 2, M, 80 years-old, treated for a left-eye choroid melanoma since January 2017, with euthyroid nodular goiter. In April 2017 (6 weeks from baseline), thyrotoxicosis was detected, with positive thyroglobulin antibodies (Tg-Ab, 244 IU/ml, nv <4) and no scintiscan uptake, as in destructive thyroiditis. Scalar-dose prednisone was initiated, and after 3 months TSH was >4.5 µIU/ml (subclinical hypothyroidism). Patient was treated with replacement doses of levothyroxine (LT-4), and continued nivolumab infusions. Conclusions. Two forms of thyrotoxicosis were reported: the first with thyroid hyperfunction and positive TRAb, the latter as a destructive thyroiditis. In both cases (mean onset after 9 weeks), the moderate severity and the appropriate management of endocrine IRAEs allowed treatment continuation.http://cab.unime.it/journals/index.php/APMB/article/view/1701immune checkpoint inhibitorsautoimmunityautoimmune thyroid diseases |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Giuseppe Giuffrida Alfredo Campennì Francesco Trimarchi Rosaria M. Ruggeri |
spellingShingle |
Giuseppe Giuffrida Alfredo Campennì Francesco Trimarchi Rosaria M. Ruggeri Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche immune checkpoint inhibitors autoimmunity autoimmune thyroid diseases |
author_facet |
Giuseppe Giuffrida Alfredo Campennì Francesco Trimarchi Rosaria M. Ruggeri |
author_sort |
Giuseppe Giuffrida |
title |
Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features |
title_short |
Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features |
title_full |
Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features |
title_fullStr |
Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features |
title_full_unstemmed |
Thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features |
title_sort |
thyroid dysfunction in patients treated with the immune checkpoint inhibitor nivolumab: different clinical features |
publisher |
Accademia Peloritana dei Pericolanti |
series |
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche |
issn |
0365-0294 1828-6550 |
publishDate |
2017-12-01 |
description |
Rationale. Immune Checkpoint Inhibitors (ICIs) are approved for some advanced neoplasms, increasing survival. ICIs block inhibitor receptors cytotoxic T lymphocyte antigen 4 (CTLA4) and programmed death-1 (PD-1) and trigger T cell-mediated immunity against tumor. Their action is accompanied by several immunity-related adverse events (IRAEs), also involving the endocrine system (pituitary, thyroid, adrenals). We report two different cases of thyrotoxicosis following administration of the anti-PD-1 nivolumab. Patients. Patient 1, M, 75 years-old, treated for non-small cell lung carcinoma (NSCLC) since September 2016, with euthyroid multinodular goiter. In January 2017 (12 weeks from baseline), he developed frank hyperthyroidism, with positive TSH-receptor antibodies (TRAb) and thyroperoxidase antibodies (TPOAb). A Tc99m thyroid scintiscan showed diffuse uptake and “cold” areas. After nivolumab withdrawal, treatment with metimazole (MMI) 5 mg per day was started and euthyroidism was resumed, so to restart the drug in May 2017. Patient 2, M, 80 years-old, treated for a left-eye choroid melanoma since January 2017, with euthyroid nodular goiter. In April 2017 (6 weeks from baseline), thyrotoxicosis was detected, with positive thyroglobulin antibodies (Tg-Ab, 244 IU/ml, nv <4) and no scintiscan uptake, as in destructive thyroiditis. Scalar-dose prednisone was initiated, and after 3 months TSH was >4.5 µIU/ml (subclinical hypothyroidism). Patient was treated with replacement doses of levothyroxine (LT-4), and continued nivolumab infusions. Conclusions. Two forms of thyrotoxicosis were reported: the first with thyroid hyperfunction and positive TRAb, the latter as a destructive thyroiditis. In both cases (mean onset after 9 weeks), the moderate severity and the appropriate management of endocrine IRAEs allowed treatment continuation. |
topic |
immune checkpoint inhibitors autoimmunity autoimmune thyroid diseases |
url |
http://cab.unime.it/journals/index.php/APMB/article/view/1701 |
work_keys_str_mv |
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