Hyperthyroidism
Hyperthyroidism related to immune checkpoint therapy is generally transient and followed by a phase of hypothyroidism where adequate subsitition is indicated. Therefore no causative treatment with antithyroid drugs is indicated. Note: High dose corticosteroids (1 mg/kg/day) are not routinely required
Symptom Grade
Grade 1Asymptomatic; clinical or diagnostic observations only intervention not indicated; |
Grade 2Symptomatic; thyroid suppression therapy indicated; limiting instrumental ADL |
Grade 3Severe symptoms; limiting self-care ADL; hospitalization indicated |
Grade 4Life-threatening consequences; urgent intervention indicated |
Management escalation pathway |
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| Persue ICPI
In the hyperthyroid phase, patients may benefit from beta blockers if symptomatic (e.g., atenolol 25–50 mg daily, titrate for HR < 90 if BP allows). Monitor closely with regular symptom evaluation and free T4 testing every 2 weeks Introduce thyroid hormones (see hypothyroidism management) if the patient becomes hypothyroid (low T4/T3, even if TSH is not elevated) Graves’ disease should be treated per standard guidelines. |
Hold ICPI for ≥ grade 3 irAEs
same as grade 2 |
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| Repeat control – FT3/FT4/TSH – In form patient of risks |
FT3/FT4/TSH – Autoimmune serology: – Anti-thyreoglobuline – Anti-thyreoperoxidase – TSI (thyroid stimulating immunoglobulins) Imaging – Thyroid echography (if nodules present they should be further explored) – Medication history: amiodarone or lithium therapy |
