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Painless thyroiditis syndrome associated with PD-1 treatment in patients with cancer
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CORONADO, Calif. — A small subset of patients with metastatic malignancies who received immunotherapy with program death-1 receptor monoclonal antibodies have been shown to have a painless thyroiditis syndrome marked by transient thyrotoxicosis and hypothyroidism, according to a presentation here.
Paul G. Walfish, CM, O.Ont, MD, FRPC, and colleagues from the Joseph and Mildred Sonshine Family Centre for Head & Neck Diseases at Mount Sinai Hospital in Toronto, evaluated 10 patients with metastatic malignancies (malignant melanoma, n=7; non-small cell lung cancer, n=3; mean aged 55 years; 60% female) to determine the incidence of painless thyroiditis. All patients had received PD-1; all were referred to an outside clinic for diagnostic confirmation and treatment after reporting symptoms that were consistent with thyroid dysfunction.
Paul G. Walfish
Sixty percent of patients were diagnosed with transient thyrotoxicosis and were treated with beta-blocker therapy. Among those patients, thyrotropin binding inhibitory immunoglobulins were negative, whereas 67% of patients had anti-thyroid antibodies documented.
After approximately 4 weeks, all patients’ thyrotoxicosis was resolved, although it was followed by hypothyroidism that required therapy with levothyroxine. All patients required hormone replacement therapy for a minimum of 6 months. No correlation was found in the patients between the oncologic response to immunotherapy and thyroid symptoms.
“In conclusion, we have demonstrated that immunotherapy with PD-1 receptor antibodies for metastatic malignancies can be accompanied by painless thyroiditis syndrome in a subset of susceptible patients,” Walfish said in a presentation. “Given the increasing application of immunotherapy for the treatment of a variety of malignancies, clinicians should monitor such patients for thyroid dysfunction.”
For more information:
Orlov S. Oral #12. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.
Disclosure: The researchers report no relevant financial disclosures.