scholarly journals OR18-06 Thyroid Function Test Abnormalities Secondary to Immune-Checkpoint Inhibitors: A Marker of Survival?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Joana Lima Ferreira ◽  
Cláudia Fernandes Costa ◽  
Sofia Castro ◽  
Joana Oliveira ◽  
Ana Paula Santos ◽  
...  
Keyword(s):  
Overall Survival ◽  
Thyroid Function ◽  
Immune Checkpoint Inhibitors ◽  
Thyroid Dysfunction ◽  
Checkpoint Inhibitors ◽  
Tumor Staging ◽  
Thyroid Function Test ◽  
Control Group ◽  
Function Test ◽  
Primary Neoplasm

Abstract Immune-checkpoint inhibitors (ICI) are monoclonal antibodies which target molecules to enhance antitumor response. Several adverse events have been described and the major ICI-related endocrinopathies are thyroid dysfunction and hypophysitis. Its occurrence has been associated with increased survival. A retrospective study of adult patients treated with ICI between March 2014 and September 2019 at an oncologic centre was performed to evaluate the impact of thyroid function test abnormalities (TFTA) in their prognosis. We excluded patients without regular monitoring of thyroid function, with previous thyroid or pituitary disease (including medical and surgical treatments), previous head/neck radiotherapy and who performed only one ICI cycle. Clinical data of all patients were examined independently by two Endocrinologists. Survival analysis was performed using the Kaplan-Meier method. Cox regression was used to evaluate associations between the occurrence of TFTA and the outcome of overall survival (OS). It was adjusted for sex, age, primary neoplasm, tumor staging and ICI. All analyses were performed using IBM-SPSS v.25 and a level of significance α=0.05 was noted. We included 161 of 205 patients, with a median age of 65 years [Interquartile range (IQR) 15] and 67% male. Most patients had melanoma (52%) and lung cancer (43%). Globally, 86, 59 and 25 patients were under pembrolizumab, nivolumab and ipilimumab, respectively. Median duration of ICI treatment was 4.4 months (IQR 7.7) and median total follow-up was 11.4 months (IQR 11.2). New onset TFTA was diagnosed in 18% of patients, at median age of 65 years (IQR 20) and 55% male. Almost half (45%) had primary hypothyroidism, 28% had central hypothyroidism and 13.8% had biphasic thyroiditis and thyrotoxicosis, each. Most TFTA (79%) occurred under pembrolizumab and nivolumab. Grade 2 CTCAE was the most frequently reported. None of the events led to ICI suspension. Patients with TFTA underwent a significant higher number of ICI cycles than control group [median 11 cycles (IQR 20) vs 7 (IQR 11), p=0.017] and had a higher period under ICI (median of 7.6 months (IQR 13.8) vs 4.2 (IQR 7.7), p=0.026). Comparison between TFTA patients and control group did not reveal statistical differences in patients’ age and sex, primary neoplasm, tumor staging and ICI. Overall survival was significantly higher in patients that developed TFTA during treatment with ICI, comparing to the control group (mean OS 3.62 years vs 1.92 years, p=0.033). The risk of mortality was higher for the control group, approximately 3 times, considering the adjustment for the covariates (HR 2.94, 95%CI=1.18 to 7.34, p=0.021). Overall survival was not affected by the covariates. Our study shows that patients under ICI that develop primary or central thyroid dysfunction had an improved survival. In these patients, the occurrence of TFTA could be a marker of a better response to ICI.

scholarly journals Incidence of Thyroid Function Test Abnormalities in Patients Receiving Immune‐Checkpoint Inhibitors for Cancer Treatment

2018 ◽  
Vol 23 (10) ◽  
pp. 1236-1241 ◽  
Author(s):  
Nisha Subhash Patel ◽  
Anais Oury ◽  
Gregory A. Daniels ◽  
Lyudmila Bazhenova ◽  
Sandip Pravin Patel
Keyword(s):  
Cancer Treatment ◽  
Thyroid Function ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Thyroid Function Test ◽  
Function Test

scholarly journals Thyroid function test in abnormal uterine bleeding

2018 ◽  
Vol 12 (2) ◽  
pp. 74-78
Author(s):  
Pramod Kattel
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Pap Smear ◽  
Abnormal Uterine Bleeding ◽  
Thyroid Function Test ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Pathological Examination ◽  
Overt Hypothyroidism ◽  
Function Test

Aims: To evaluate and detect the thyroid dysfunction in patients with abnormal uterine bleeding (AUB) from puberty to menopause.Methods: This is an observational descriptive study of 90 patients of abnormal uterine bleeding at Paropakar Maternity and Women’s Hospital, Kathmandu from 17th January 2016 to 16th January 2017. Besides thyroid function test Pap smear, endometrial biopsy and histo-pathological examination of uterus following hysterectomy was done in selected cases.Results: The incidence of AUB was 6.2 % with mean age of 37 years. The most common presenting complaint was menorrhagia (36.7%) followed by metrorrhagia (23.3%). Thyroid dysfunction accounted for 20% of AUB with major share occupied by subclinical hypothyroidism (11%) and least by hyperthyroidism (1%). The most common association of thyroid dysfunction with AUB was overt hypothyroidism (27.3%) with menorrhagia. Non-structural cases of AUB accounted for 30.4% of thyroid dysfunction.Conclusions: This study shows that thyroid dysfunction plays significant role for AUB so it is wise enough to perform TFT on routine basis in order to avoid unnecessary hormonal treatment with Estrogen, Progesterone or their combination and even the hysterectomies.

Patterns of thyroid dysfunctions during treatment with immune checkpoint inhibitors (ICI) in 59 solid cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Yong Jiang ◽  
Li Yang ◽  
Yin Han ◽  
Yongshen Zhang ◽  
Feng-Ming Kong
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Thyroid Function ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Thyroid Dysfunction ◽  
Checkpoint Inhibitors ◽  
Small Cell ◽  
Small Cell Lung ◽  
Thyroid Dysfunctions

e18567 Background: Immune checkpoint inhibitors (ICI) have now become the mainstay treatment in patients with many kinds of cancers. Thyroid dysfunction as the most common endocrine toxicity is poorly understood. This study aimed to report hypothyroidism and exam its changing dynamtic in our first series of patients treated with ICI. Methods: This is a retrospective study. Patients received nivolumab or pembrolizumab between July 2018 and December 2019 were considered. Patient must have euthyroidism within the 3 months before immunotherapy and those had previous use of levothyroxine were excluded. They were monitored by thyroid function tests every cycle until stopping ICI. Patients must have received at least 3 cycles of antibody treatment. Results: Among 89 patients treated, 59 met the inclusion criteria. There were 33 males, 26 females, including 26 (44.1%) nivolumab, and 33 (55.9%) pembrolizumab. Median age was 62 years [range: 27-88]). Cancer diagnoses observed were non small cell lung cancer 17(28.8%), small cell lung cancer 4 (6.8%),liver cancer 9 (15.3%), head and neck cancer 5 (8.5%), esophageal cancer4 (6.8%) colon cancer 3 (5.1%), nasopharygeal carcinoma 3 (5.1%) melanoma 3 (5.1%) and other cancers 11(18.6%). There were 9 patients (15.3%) developed a thyroid dysfunction, including 5 females. Four patients had thyrotoxicosis (median onset: 8 weeks) followed by hypothyroidism. There were three types of thyroid dysfunctions: the first type patients 3 (33.3%) had a brief time period of TSH flair (peak 17.4-57.8) after the first cycle of ICI, followed by TSH dramatic drop companied with rising fT4, which usually returned to normal level during 3-4 cycles of . The other 4 patients (44.4%) with thyroid dysfunction presented with remarkably elevated TSH (15.43-125.2) after 3.5-10 months’ treatment, followed by hypothyroidism development with a need of levothyroxine. The remaining 1 patient had a third type of thyroid dysfunction with elevated TSH, elavated more while the treatment continue, the patient should be given levothyroxine as soon as possible. Additionally, 1 patient developed hypopituitarism presented with both low level of TSH and fT4 after 10 month treatment. There was no significant difference in patient characteristics between patients with hypothyroidism and those without. Conclusions: There are heterogeneity in thyroid function and hypothyroidism after ICI. Before more experience is gained, frequent monitoring of thyroid function during ICI is warranted for prompt management of the hypothyroidism.

THYROID DYSFUNCTION, RECOVERY, AND PROGNOSIS IN MELANOMA PATIENTS TREATED WITH IMMUNE CHECKPOINT INHIBITORS: A RETROSPECTIVE REVIEW

2020 ◽  
Vol 26 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Mazen Al Mushref ◽  
Paul A. Guido ◽  
Frances A. Collichio ◽  
Dominic T. Moore ◽  
David R. Clemmons
Keyword(s):  
Thyroid Function ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Thyroid Dysfunction ◽  
Checkpoint Inhibitors ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Melanoma Patients ◽  
Recovery Group ◽  
Stimulating Hormone

Objective: To describe thyroid dysfunction, factors associated with thyroid recovery, and survival in melanoma patients treated with immune checkpoint inhibitors that developed thyroid immune-related adverse events (irAEs). Methods: This was a retrospective study in a tertiary center from 2010–2017. We reviewed the charts of patients with melanoma that developed thyroid dysfunction after checkpoint inhibitor therapy. Cases with thyroid irAEs were grouped by recovery of thyroid function at 1 year. We collected a timeline of thyroid function tests, medication exposure, and survival and compared variables between the groups. We studied survival in comparison to a matched group without thyroid dysfunction. Results: A total of 186 melanoma patients received checkpoint inhibitors, and 17 (9%) had thyroid irAEs. Median time to abnormal thyroid-stimulating hormone was 38 days and followed a pattern of thyroiditis. Seven of 17 had thyroid recovery. In the no-recovery group, free thyroxine (T4) was often above 2 ng/dL (5/10 in no recovery, 0/7 in recovery; P = .04). In the recovery group, irAE grade was significantly lower, with 7/7 grade 1 ( P = .004). Exposure to glucocorticoids was associated with recovery (3/10 in no recovery, 6/7 in recovery; P = .049). There was no difference in overall survival between the thyroid dysfunction group and controls, or between those that received glucocorticoids or not. Conclusion: Certain aspects of thyroid irAEs may correlate with thyroid recovery, including grade 1 thyroid irAEs, exposure to glucocorticoids, and peak free T4 levels less than 2 ng/dL. Thyroid irAEs did not appear to be associated with change in survival nor did exposure to glucocorticoids. Abbreviations: ASCO = American Society of Clinical Oncology; CTLA-4 = cytotoxic T-lymphocyte–associated protein 4; irAE = immune-related adverse event; PD-1 = programmed cell death protein 1; T4 = thyroxine; TSH = thyroid-stimulating hormone

scholarly journals Status of Thyroid Disorder among the Thyroid Function Test Samples Received in a Laboratory among Postmenopausal Women: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (234) ◽  
Author(s):  
Manoranjan Shrestha ◽  
Reshmi Shrestha
Keyword(s):  
Postmenopausal Women ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Thyroid Function Test ◽  
Cross Sectional Study ◽  
Reference Laboratory ◽  
Sectional Study ◽  
Cross Sectional ◽  
Function Test

Introduction: Thyroid dysfunction prevalence is high in females worldwide which increases with age. Postmenopausal and elderly women are particularly at risk of developing comorbidities and mortality related to thyroid dysfunction. We aimed to study the prevalence of thyroid dysfunction in postmenopausal women in the National Reference Laboratory of Nepal. Methods: A descriptive cross-sectional study was conducted in National Reference Laboratory from January 2019 to June 2019 including postmenopausal females, ≥49 years. The database of thyroid function test result was used for statistical analysis and proportion of thyroid dysfunction was calculated. The data was collected after approval from the institutional review committee. Statistical Package for Social Sciences version 21 was used to study descriptive data. Results: Out of a total of 160 postmenopausal females with thyroid function tests, 71 (44.4%) had thyroid dysfunction. Subclinical hypothyroidism was the frequently occurring thyroid dysfunction 51 (32%) followed by subclinical hyperthyroidism 13 (8%), hypothyroidism 3 (2%) and hyperthyroidism 3 (2%). In our study population, thyroid dysfunction peaked at 49 to 58 years of age interval 53 (33.1%) and subclinical hypothyroidism was the most frequent form 38 (23.7%). Conclusions: Subclinical hypothyroidism was the common thyroid dysfunction in postmenopausal age which peaked at 49 to 58 years of age group. Early postmenopausal females are predisposed to increased risk of comorbidities (cardiovascular disease, osteoporosis with high fracture, depression) which could be exacerbated with thyroid dysfunction; therefore awareness of thyroid dysfunction prevalence and thyroid screening for early management seems appropriate in Nepalese postmenopausal women.

Thyroid Disease in Pregnancy

2008 ◽  
Vol 04 (01) ◽  
pp. 100
Author(s):  
N Pearce Elizabeth ◽  
M Leung Angela
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Autoimmune Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Thyroid Function Test ◽  
Autoimmune Thyroid ◽  
Thyroid Screening ◽  
Function Test ◽  
In Pregnancy

The spectrum of thyroid disease in pregnancy has implications for both the mother and the developing fetus. Here we review the interpretation of thyroid function test values, thyrotoxicosis, hypothyroidism, iodine requirements, autoimmune thyroid disease, and thyroid screening recommendations as they pertain to pregnant women. It should be noted that the management of thyroid dysfunction in pregnancy should be closely co-ordinated with obstetricians and other providers.

scholarly journals Thyroid Dysfunction and Cytological Patterns among Patients Requested for Thyroid Function Test in an Endemic Goiter Area of Gondar, North West Ethiopia

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel Asmelash ◽  
Kumlgn Tesfa ◽  
Belete Biadgo
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Endemic Goiter ◽  
Wide Spectrum ◽  
Nodular Goiter ◽  
Thyroid Function Test ◽  
Subclinical Hyperthyroidism ◽  
Cross Sectional ◽  
Function Test ◽  
Study Participants

Background. Thyroid dysfunction is the most common endocrine disorder in clinical practice, and about half of the population with thyroid dysfunction remains undiagnosed. There is a fairly wide spectrum of thyroid dysfunction, which can be identified by patterns of thyroid function test results. The prevalence of thyroid dysfunction among the population varies in different studies. Methods. A cross-sectional study was conducted from February 8th to April 8th, 2017, among patients who requested for the thyroid function test in an endemic goiter area at the Gondar Hospital, University of Gondar. A pretested structured questionnaire was used to collect the data. Three milliliters of blood samples was collected in a plain test tube and centrifuged for serum separation. The thyroid function test was done by using the MINI-VIDAS automation following the manufacturer manual (Setema PLC, Italy). Data were entered and analyzed using SPSS version 20. Descriptive statistics were used for data presentation, and P value < 0.05 was considered significant. Result. Of the total 384 study participants, 346 (90.1%) were females and the study participants’ mean age was 38 ± 13.9 years. The overall thyroid dysfunction prevalence was 26.3% (101): 1.6% was identified as subclinical hypothyroidism, 0.5% hypothyroidism, 9.6% subclinical hyperthyroidism, and 14.6% hyperthyroidism, and 23.4% had goiter. Furthermore, for cytological pattern analysis, 144 study participants who fulfilled indications for fine-needle aspiration cytology (FNAC) in thyroid nodules were included. Of the total, 3 (2.1%) had thyroid carcinoma, 46 (32%) had cystic degenerated follicular cells, and 82 (57%) had nodular thyroid goiter. In addition, a clinical presentation of a total of 144 study participants, showed lymphadenites in 7 participants (4.8%), hypertension in 9 (6.2%), and cardiac failure in 12 (8.3%). Conclusion. The prevalence of thyroid dysfunction was high. The majority of thyroid dysfunction cases were newly diagnosed and more common in females. In addition, the most common disorders were subclinical hyperthyroidism and hyperthyroidism. Follicular cell with cyst degeneration and thyroid nodular goiter were the predominant FNAC findings. For early diagnosis and appropriate intervention in goiter endemic areas, the thyroid function test should be closely monitored.

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