A decrease in peripheral thyroid hormone conversion efficiency in patients treated with immune checkpoint inhibitors and L‐T3 as a possible alternative therapeutic escape option. (21st April 2022)

• Record Type: Journal Article
• Authors: Verelst, Faro R.; Beyens, Michiel Marcel Jozef; Vandenbroucke, Elke; Forceville, Katheleen; (Th. B) Twickler, Marcel
• Is Part Of: European journal of clinical investigation. Volume 52:Number 7(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-04-21
• Subjects: hypothyroidism -- immune checkpoint inhibitors -- oncology -- peripheral T4‐T3 conversion efficiency -- T‐3 as rescue therapy; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.13790
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Hypothyroidism is a frequently occurring side effect in patients under treatment with immune checkpoint inhibitors (ICIs). Actually, the origin of hypothyroidism with ICI use is classified as a primary (thyroid) or as secondary/tertiary hypothyroidism (hypothalamus‐pituitary). Treatment consists of levothyroxine (L‐T4) substitution. Recently, we were rarely confronted with a clinically overt hypothyroidism in three patients under treatment with ICIs who were non‐responsive to T4 therapy. As a therapeutical escape, liothyronine (L‐T3) was started with a significant clinical and/or biochemical improvement suggesting an underlying functional defect in the peripheral free T4 (fT4) to free T3 (fT3) conversion (as supported by calculation of SPINA‐GD). Against this background, we discussed our three patients along an extended review of this clinical topic.