CONTEXT Explore the clinical characteristics and influencing factors of immune thyroid dysfunction (ITD) caused by immune checkpoint inhibitors (ICIs) in the treatment of malignant tumors. METHODS This was a retrospective study of cancer patients treated with ICIs between January 2019 and December 2021 at the Second Affiliated Hospital of Nanchang University. According to the occurrence of thyroid dysfunction, patients were divided into an ITD group and non-ITD group. We describe the clinical characteristics, autoantibody levels, and their impact on prognosis of patients with ICI-related ITD. RESULT A total of 560 cases meeting the criteria were included, with a median follow-up time of 11.0 months. The incidence of ITD was 50.7%. Baseline TSH levels (OR, 1.935/mcIU/L; 95% CI, 1.613-2.321; P < .001) and combination targeted therapy (OR, 2.101; 95% CI, 1.433-3.079; P < .001) were most strongly associated with the occurrence of ITD. The median time to ITD in patients receiving medication with ICIs was 73 (34.5-149) days. Of the 87 patients initially diagnosed with hyperthyroid ITD, 46 (52.9%) progressed to hypothyroidism over the course of the disease. Baseline anti-thyroglobulin antibody abnormalities were strongly associated with the occurrence of ITD (OR, 67.393; 95% CI, 5.637-805.656; P = .001). Overall survival was significantly lower in patients who did not develop ITD than in those who did (hazard ratio, 0.523; 95% CI, 0.599-0.97; P < .001). CONCLUSION The incidence of ICI-related ITD is high, and the course of the disease is rapidly changing, and thyroid function in patients treated with immunotherapy should be monitored to detect ITD and permit early intervention.

中文翻译：

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免疫检查点抑制剂相关甲状腺功能障碍的临床特征及影响因素。

背景探讨免疫检查点抑制剂（ICIs）治疗恶性肿瘤引起免疫性甲状腺功能障碍（ITD）的临床特点及影响因素。方法这是对2019年1月至2021年12月在南昌大学第二附属医院接受ICIs治疗的癌症患者的回顾性研究。根据甲状腺功能障碍的发生情况将患者分为ITD组和非ITD组。我们描述了 ICI 相关 ITD 患者的临床特征、自身抗体水平及其对预后的影响。结果共纳入符合标准的病例560例，中位随访时间11.0个月。ITD的发生率为50.7%。基线 TSH 水平（OR，1.935/mcIU/L；95% CI，1.613-2.321；P < .001）和联合靶向治疗（OR，2.101；95% CI，1.433-3.079；P < .001）最强与ITD的发生有关。接受 ICI 治疗的患者达到 ITD 的中位时间为 73 (34.5-149) 天。在最初诊断为甲状腺功能亢进 ITD 的 87 名患者中，46 名 (52.9%) 在病程中进展为甲状腺功能减退症。基线抗甲状腺球蛋白抗体异常与 ITD 的发生密切相关（OR，67.393；95% CI，5.637-805.656；P = .001）。未发生 ITD 的患者的总生存率显着低于发生 ITD 的患者（风险比，0.523；95% CI，0.599-0.97；P < .001）。结论 ICI相关ITD发生率高，病程变化快，免疫治疗患者应监测甲状腺功能，及时发现ITD并早期干预。