Thyroid features of the 20 patients at the onset of thyrotoxicosis induced by immunotherapy
| Patient . | Sex, M/F . | Age, y . | Cancer . | Drug . | Time from ICI start, mo . | FT4, ng/L . | FT3, ng/L . | TgAbs, IU/mL . | TPOAbs, IU/mL . | TRAbs, IU/mL . | Tg, ng/mL . | Urinary iodine, µg/L . | Thyroid volume, mL . | 99mTc-uptake, Sci+/Sci– . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | 69 | NSCLC | Pembro | 1 | 30.5 | 10.7 | 69 | 125 | < 0.1 | 0.91 | 219 | 4.6 | Sci– |
| 2 | F | 46 | NSCLC | Nivo | 3 | 19.7 | 4.3 | 13 | < 1.0 | < 0.1 | 4.96 | 190 | 6.1 | Sci– |
| 3 | M | 73 | HCC | Pembro | 2 | 28.5 | 6.7 | < 1.0 | 24 | < 0.1 | 3.7 | 180 | 6.5 | Sci– |
| 4 | M | 53 | NSCLC | Atezo | 2 | 29.8 | 9.1 | 180 | < 1.0 | < 0.1 | 4.9 | 286 | 7.0 | Sci– |
| 5 | F | 41 | MEL | Nivo | 4 | 21.1 | 5.9 | < 1.0 | < 1.0 | < 0.1 | 2.2 | 290 | 9.0 | Sci– |
| 6 | F | 49 | MEL | Nivo | 5 | 29.9 | 11.0 | 20 | < 1.0 | < 0.1 | 11.0 | 190 | 11.4 | Sci– |
| 7 | M | 71 | NSCLC | Pembro | 6 | 33.0 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 2.7 | 190 | 12.0 | Sci– |
| 8 | M | 77 | MEL | Nivo | 1 | 17.6 | 3.4 | 12 | < 1.0 | < 0.1 | 0.72 | 200 | 12.1 | Sci– |
| 9 | M | 62 | RCC | Nivo | 2 | 39.5 | 12.2 | 262 | 967 | < 0.1 | 6.97 | 252 | 22.0 | Sci– |
| 10 | M | 71 | NSCLC | Nivo | 2 | 19.1 | 3.9 | < 1.0 | < 1.0 | < 0.1 | 2.98 | 221 | 22.8 | Sci– |
| 11 | F | 71 | NSCLC | Pembro | 2 | 37.1 | 5.2 | 178 | < 1.0 | 0.12 | 79.7 | 276 | 23.7 | Sci– |
| 12 | M | 70 | MEL | Nivo | 9 | 30.9 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 9.2 | 280 | 25.3 | Sci– |
| 13 | M | 65 | MEL | Nivo | 1 | 31.1 | 8.7 | 400 | 199 | < 0.1 | 1.3 | 190 | 36.2 | Sci– |
| 14 | M | 67 | NSCLC | Pembro | 2 | 35.5 | 5.7 | < 1.0 | < 1.0 | < 0.1 | 81.0 | 200 | 37.0 | Sci– |
| 15 | M | 74 | HCC | Durva | 1 | 43.8 | 7.3 | 2000 | < 1.0 | 0.1 | 1.8 | 283 | 38.7 | Sci– |
| 16 | M | 51 | NSCLC | Nivo | 2 | 29.3 | 11.2 | < 1.0 | < 1.0 | < 0.1a | 21.0 | 190 | 16.4 | Sci+ |
| 17 | F | 55 | NSCLC | Nivo | 1 | 26.6 | 5.6 | < 1.0 | < 1.0 | < 0.1a | 18.8 | 220 | 25.3 | Sci+ |
| 18 | F | 55 | NSCLC | Pembro | 2 | 30.7 | 7.2 | 1000 | 70 | < 0.1a | 2.7 | 290 | 27.9 | Sci+ |
| 19 | M | 51 | MEL | Pembro | 1 | 20.2 | 4.4 | < 1.0 | < 1.0 | < 0.1a | 3.8 | 298 | 42.0 | Sci+ |
| 20 | M | 71 | NSCLC | Atezo | 2 | 29.7 | 7.7 | < 1.0 | < 1.0 | < 0.1a | 79.1 | 216 | 48.0 | Sci+ |
| Patient . | Sex, M/F . | Age, y . | Cancer . | Drug . | Time from ICI start, mo . | FT4, ng/L . | FT3, ng/L . | TgAbs, IU/mL . | TPOAbs, IU/mL . | TRAbs, IU/mL . | Tg, ng/mL . | Urinary iodine, µg/L . | Thyroid volume, mL . | 99mTc-uptake, Sci+/Sci– . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | 69 | NSCLC | Pembro | 1 | 30.5 | 10.7 | 69 | 125 | < 0.1 | 0.91 | 219 | 4.6 | Sci– |
| 2 | F | 46 | NSCLC | Nivo | 3 | 19.7 | 4.3 | 13 | < 1.0 | < 0.1 | 4.96 | 190 | 6.1 | Sci– |
| 3 | M | 73 | HCC | Pembro | 2 | 28.5 | 6.7 | < 1.0 | 24 | < 0.1 | 3.7 | 180 | 6.5 | Sci– |
| 4 | M | 53 | NSCLC | Atezo | 2 | 29.8 | 9.1 | 180 | < 1.0 | < 0.1 | 4.9 | 286 | 7.0 | Sci– |
| 5 | F | 41 | MEL | Nivo | 4 | 21.1 | 5.9 | < 1.0 | < 1.0 | < 0.1 | 2.2 | 290 | 9.0 | Sci– |
| 6 | F | 49 | MEL | Nivo | 5 | 29.9 | 11.0 | 20 | < 1.0 | < 0.1 | 11.0 | 190 | 11.4 | Sci– |
| 7 | M | 71 | NSCLC | Pembro | 6 | 33.0 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 2.7 | 190 | 12.0 | Sci– |
| 8 | M | 77 | MEL | Nivo | 1 | 17.6 | 3.4 | 12 | < 1.0 | < 0.1 | 0.72 | 200 | 12.1 | Sci– |
| 9 | M | 62 | RCC | Nivo | 2 | 39.5 | 12.2 | 262 | 967 | < 0.1 | 6.97 | 252 | 22.0 | Sci– |
| 10 | M | 71 | NSCLC | Nivo | 2 | 19.1 | 3.9 | < 1.0 | < 1.0 | < 0.1 | 2.98 | 221 | 22.8 | Sci– |
| 11 | F | 71 | NSCLC | Pembro | 2 | 37.1 | 5.2 | 178 | < 1.0 | 0.12 | 79.7 | 276 | 23.7 | Sci– |
| 12 | M | 70 | MEL | Nivo | 9 | 30.9 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 9.2 | 280 | 25.3 | Sci– |
| 13 | M | 65 | MEL | Nivo | 1 | 31.1 | 8.7 | 400 | 199 | < 0.1 | 1.3 | 190 | 36.2 | Sci– |
| 14 | M | 67 | NSCLC | Pembro | 2 | 35.5 | 5.7 | < 1.0 | < 1.0 | < 0.1 | 81.0 | 200 | 37.0 | Sci– |
| 15 | M | 74 | HCC | Durva | 1 | 43.8 | 7.3 | 2000 | < 1.0 | 0.1 | 1.8 | 283 | 38.7 | Sci– |
| 16 | M | 51 | NSCLC | Nivo | 2 | 29.3 | 11.2 | < 1.0 | < 1.0 | < 0.1a | 21.0 | 190 | 16.4 | Sci+ |
| 17 | F | 55 | NSCLC | Nivo | 1 | 26.6 | 5.6 | < 1.0 | < 1.0 | < 0.1a | 18.8 | 220 | 25.3 | Sci+ |
| 18 | F | 55 | NSCLC | Pembro | 2 | 30.7 | 7.2 | 1000 | 70 | < 0.1a | 2.7 | 290 | 27.9 | Sci+ |
| 19 | M | 51 | MEL | Pembro | 1 | 20.2 | 4.4 | < 1.0 | < 1.0 | < 0.1a | 3.8 | 298 | 42.0 | Sci+ |
| 20 | M | 71 | NSCLC | Atezo | 2 | 29.7 | 7.7 | < 1.0 | < 1.0 | < 0.1a | 79.1 | 216 | 48.0 | Sci+ |
Normal ranges: FT4 8 to 18 ng/L; FT3 2.5 to 5.0 pmol/L; TgAbs less than 30 IU/mL; TPOAbs less than 10 IU/mL; TRAbs less than 1.5 IU/mL; Tg less than 30 µg/L; urinary iodine 100 to 300 µg/L; normal thyroid volume: 12.1 mL (female); 16.5 mL (male).
Sci+ indicates patients with formation of a thyroid image due to a normal/increased uptake of technetium; Sci– indicates patients without formation of a thyroid image due to an absent uptake.
Abbreviations: Atezo, atezolizumab (anti-PD-L1); Durva, durvalumab (anti-PD-L1); F, female; FT3, free 3,5,3′-triiodothyronine; FT4, free thyroxine; HCC, hepatocellular carcinoma; ICI, immune checkpoint inhibitor; M, male; MEL, melanoma; Nivo, nivolumab; NSCLC, non–small cell lung cancer; Pembro, pembrolizumab (anti-PD1); PD1, programmed cell death protein-1; PD-L1, programmed cell death protein ligand-1; RCC, renal cell carcinoma; Tc, technecium; Tg, thyroglobulin; TgAbs, thyroglobulin antibodies; TPOAbs, thyroperoxidase antibodies; TRAbs, thyrotropin receptor antibodies.
aTRAb were negative at 3 different times during the follow-up.
Thyroid features of the 20 patients at the onset of thyrotoxicosis induced by immunotherapy
| Patient . | Sex, M/F . | Age, y . | Cancer . | Drug . | Time from ICI start, mo . | FT4, ng/L . | FT3, ng/L . | TgAbs, IU/mL . | TPOAbs, IU/mL . | TRAbs, IU/mL . | Tg, ng/mL . | Urinary iodine, µg/L . | Thyroid volume, mL . | 99mTc-uptake, Sci+/Sci– . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | 69 | NSCLC | Pembro | 1 | 30.5 | 10.7 | 69 | 125 | < 0.1 | 0.91 | 219 | 4.6 | Sci– |
| 2 | F | 46 | NSCLC | Nivo | 3 | 19.7 | 4.3 | 13 | < 1.0 | < 0.1 | 4.96 | 190 | 6.1 | Sci– |
| 3 | M | 73 | HCC | Pembro | 2 | 28.5 | 6.7 | < 1.0 | 24 | < 0.1 | 3.7 | 180 | 6.5 | Sci– |
| 4 | M | 53 | NSCLC | Atezo | 2 | 29.8 | 9.1 | 180 | < 1.0 | < 0.1 | 4.9 | 286 | 7.0 | Sci– |
| 5 | F | 41 | MEL | Nivo | 4 | 21.1 | 5.9 | < 1.0 | < 1.0 | < 0.1 | 2.2 | 290 | 9.0 | Sci– |
| 6 | F | 49 | MEL | Nivo | 5 | 29.9 | 11.0 | 20 | < 1.0 | < 0.1 | 11.0 | 190 | 11.4 | Sci– |
| 7 | M | 71 | NSCLC | Pembro | 6 | 33.0 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 2.7 | 190 | 12.0 | Sci– |
| 8 | M | 77 | MEL | Nivo | 1 | 17.6 | 3.4 | 12 | < 1.0 | < 0.1 | 0.72 | 200 | 12.1 | Sci– |
| 9 | M | 62 | RCC | Nivo | 2 | 39.5 | 12.2 | 262 | 967 | < 0.1 | 6.97 | 252 | 22.0 | Sci– |
| 10 | M | 71 | NSCLC | Nivo | 2 | 19.1 | 3.9 | < 1.0 | < 1.0 | < 0.1 | 2.98 | 221 | 22.8 | Sci– |
| 11 | F | 71 | NSCLC | Pembro | 2 | 37.1 | 5.2 | 178 | < 1.0 | 0.12 | 79.7 | 276 | 23.7 | Sci– |
| 12 | M | 70 | MEL | Nivo | 9 | 30.9 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 9.2 | 280 | 25.3 | Sci– |
| 13 | M | 65 | MEL | Nivo | 1 | 31.1 | 8.7 | 400 | 199 | < 0.1 | 1.3 | 190 | 36.2 | Sci– |
| 14 | M | 67 | NSCLC | Pembro | 2 | 35.5 | 5.7 | < 1.0 | < 1.0 | < 0.1 | 81.0 | 200 | 37.0 | Sci– |
| 15 | M | 74 | HCC | Durva | 1 | 43.8 | 7.3 | 2000 | < 1.0 | 0.1 | 1.8 | 283 | 38.7 | Sci– |
| 16 | M | 51 | NSCLC | Nivo | 2 | 29.3 | 11.2 | < 1.0 | < 1.0 | < 0.1a | 21.0 | 190 | 16.4 | Sci+ |
| 17 | F | 55 | NSCLC | Nivo | 1 | 26.6 | 5.6 | < 1.0 | < 1.0 | < 0.1a | 18.8 | 220 | 25.3 | Sci+ |
| 18 | F | 55 | NSCLC | Pembro | 2 | 30.7 | 7.2 | 1000 | 70 | < 0.1a | 2.7 | 290 | 27.9 | Sci+ |
| 19 | M | 51 | MEL | Pembro | 1 | 20.2 | 4.4 | < 1.0 | < 1.0 | < 0.1a | 3.8 | 298 | 42.0 | Sci+ |
| 20 | M | 71 | NSCLC | Atezo | 2 | 29.7 | 7.7 | < 1.0 | < 1.0 | < 0.1a | 79.1 | 216 | 48.0 | Sci+ |
| Patient . | Sex, M/F . | Age, y . | Cancer . | Drug . | Time from ICI start, mo . | FT4, ng/L . | FT3, ng/L . | TgAbs, IU/mL . | TPOAbs, IU/mL . | TRAbs, IU/mL . | Tg, ng/mL . | Urinary iodine, µg/L . | Thyroid volume, mL . | 99mTc-uptake, Sci+/Sci– . |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | F | 69 | NSCLC | Pembro | 1 | 30.5 | 10.7 | 69 | 125 | < 0.1 | 0.91 | 219 | 4.6 | Sci– |
| 2 | F | 46 | NSCLC | Nivo | 3 | 19.7 | 4.3 | 13 | < 1.0 | < 0.1 | 4.96 | 190 | 6.1 | Sci– |
| 3 | M | 73 | HCC | Pembro | 2 | 28.5 | 6.7 | < 1.0 | 24 | < 0.1 | 3.7 | 180 | 6.5 | Sci– |
| 4 | M | 53 | NSCLC | Atezo | 2 | 29.8 | 9.1 | 180 | < 1.0 | < 0.1 | 4.9 | 286 | 7.0 | Sci– |
| 5 | F | 41 | MEL | Nivo | 4 | 21.1 | 5.9 | < 1.0 | < 1.0 | < 0.1 | 2.2 | 290 | 9.0 | Sci– |
| 6 | F | 49 | MEL | Nivo | 5 | 29.9 | 11.0 | 20 | < 1.0 | < 0.1 | 11.0 | 190 | 11.4 | Sci– |
| 7 | M | 71 | NSCLC | Pembro | 6 | 33.0 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 2.7 | 190 | 12.0 | Sci– |
| 8 | M | 77 | MEL | Nivo | 1 | 17.6 | 3.4 | 12 | < 1.0 | < 0.1 | 0.72 | 200 | 12.1 | Sci– |
| 9 | M | 62 | RCC | Nivo | 2 | 39.5 | 12.2 | 262 | 967 | < 0.1 | 6.97 | 252 | 22.0 | Sci– |
| 10 | M | 71 | NSCLC | Nivo | 2 | 19.1 | 3.9 | < 1.0 | < 1.0 | < 0.1 | 2.98 | 221 | 22.8 | Sci– |
| 11 | F | 71 | NSCLC | Pembro | 2 | 37.1 | 5.2 | 178 | < 1.0 | 0.12 | 79.7 | 276 | 23.7 | Sci– |
| 12 | M | 70 | MEL | Nivo | 9 | 30.9 | 8.8 | < 1.0 | < 1.0 | < 0.1 | 9.2 | 280 | 25.3 | Sci– |
| 13 | M | 65 | MEL | Nivo | 1 | 31.1 | 8.7 | 400 | 199 | < 0.1 | 1.3 | 190 | 36.2 | Sci– |
| 14 | M | 67 | NSCLC | Pembro | 2 | 35.5 | 5.7 | < 1.0 | < 1.0 | < 0.1 | 81.0 | 200 | 37.0 | Sci– |
| 15 | M | 74 | HCC | Durva | 1 | 43.8 | 7.3 | 2000 | < 1.0 | 0.1 | 1.8 | 283 | 38.7 | Sci– |
| 16 | M | 51 | NSCLC | Nivo | 2 | 29.3 | 11.2 | < 1.0 | < 1.0 | < 0.1a | 21.0 | 190 | 16.4 | Sci+ |
| 17 | F | 55 | NSCLC | Nivo | 1 | 26.6 | 5.6 | < 1.0 | < 1.0 | < 0.1a | 18.8 | 220 | 25.3 | Sci+ |
| 18 | F | 55 | NSCLC | Pembro | 2 | 30.7 | 7.2 | 1000 | 70 | < 0.1a | 2.7 | 290 | 27.9 | Sci+ |
| 19 | M | 51 | MEL | Pembro | 1 | 20.2 | 4.4 | < 1.0 | < 1.0 | < 0.1a | 3.8 | 298 | 42.0 | Sci+ |
| 20 | M | 71 | NSCLC | Atezo | 2 | 29.7 | 7.7 | < 1.0 | < 1.0 | < 0.1a | 79.1 | 216 | 48.0 | Sci+ |
Normal ranges: FT4 8 to 18 ng/L; FT3 2.5 to 5.0 pmol/L; TgAbs less than 30 IU/mL; TPOAbs less than 10 IU/mL; TRAbs less than 1.5 IU/mL; Tg less than 30 µg/L; urinary iodine 100 to 300 µg/L; normal thyroid volume: 12.1 mL (female); 16.5 mL (male).
Sci+ indicates patients with formation of a thyroid image due to a normal/increased uptake of technetium; Sci– indicates patients without formation of a thyroid image due to an absent uptake.
Abbreviations: Atezo, atezolizumab (anti-PD-L1); Durva, durvalumab (anti-PD-L1); F, female; FT3, free 3,5,3′-triiodothyronine; FT4, free thyroxine; HCC, hepatocellular carcinoma; ICI, immune checkpoint inhibitor; M, male; MEL, melanoma; Nivo, nivolumab; NSCLC, non–small cell lung cancer; Pembro, pembrolizumab (anti-PD1); PD1, programmed cell death protein-1; PD-L1, programmed cell death protein ligand-1; RCC, renal cell carcinoma; Tc, technecium; Tg, thyroglobulin; TgAbs, thyroglobulin antibodies; TPOAbs, thyroperoxidase antibodies; TRAbs, thyrotropin receptor antibodies.
aTRAb were negative at 3 different times during the follow-up.
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