Background: Immune checkpoint inhibitors (ICI) foster T lymphocytes to fight cancer, but they can also trigger immune-related adverse events (irAE) in various organs, including thyroid dysfunction that can manifest itself in terms of both hyperthyroidism and hypothyroidism or subclinical disease. Objective: Based on previous observations, this study evaluated the impact of oncological immunotherapy on the development of thyroid dysfunction in a cohort of patients treated with ICI at our institution. Methods: We collected 10 cases of thyroid irAE that emerged from 24 cancer patients treated with immunotherapy, belonging to a cohort of 120 patients who were sent to our clinic by the Oncology Department of our institution, between December 2016 and March 2020. Results: From the analysis of the data, thyroid irAEs emerged after a median time of 9 weeks, and they occurred mainly in females. Regardless of the initial presentation (thyroiditis with thyrotoxicosis, hypothyroidism, or worsening of the previous subclinical hypothyroidism), later all patients developed persistent hypothyroidism which required hormone replacement therapy with levothyroxine. This finding was confirmed by a statistically significant increase in the median value of TSH (thyroid-stimulating hormone) between the pre-ICI treatment and subsequent phases and, for the first time, by a reduction in the median value of the thyroid volume estimated by neck ultrasound, a sign of destructive thyroiditis. Conclusion: Our results confirm that patients undergoing immunotherapy should be monitored for potential thyroid dysfunction with biochemical assessments and changes in thyroid volume estimated by ultrasound could be helpful in the diagnostic work-up.

中文翻译：

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免疫检查点抑制剂诱发的甲状腺疾病：单中心经验

背景：免疫检查点抑制剂 (ICI) 培养 T 淋巴细胞来对抗癌症，但它们也会在各种器官中引发免疫相关不良事件 (irAE)，包括可表现为甲状腺功能亢进症和甲状腺功能减退症或亚临床疾病的甲状腺功能障碍。目的：根据之前的观察，本研究评估了肿瘤免疫治疗对我们机构接受 ICI 治疗的一组患者甲状腺功能障碍发展的影响。方法：我们收集了 24 名接受免疫治疗的癌症患者出现的 10 例甲状腺 irAE，这些患者属于 2016 年 12 月至 2020 年 3 月期间由我们机构肿瘤科送到我们诊所的 120 名患者队列。结果：来自数据分析，甲状腺 irAE 出现的中位时间为 9 周，并且主要发生在女性中。无论最初的表现如何（伴有甲状腺毒症的甲状腺炎、甲状腺功能减退症或先前亚临床甲状腺功能减退症的恶化），所有患者后来都出现了持续性甲状腺功能减退症，需要使用左旋甲状腺素进行激素替代治疗。这一发现得到了 ICI 前治疗和后续阶段之间 TSH（促甲状腺激素）中值统计学显着增加的证实，并且首次通过以下方法估计的甲状腺体积中值减少颈部超声，破坏性甲状腺炎的征兆。结论：