{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:51:45Z","timestamp":1770742305361,"version":"3.49.0"},"reference-count":26,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Thyrotoxicosis is a common immune-related adverse event in patients treated with programmed cell death protein-1 (PD1) or programmed cell death protein ligand-1 (PD-L1) blockade. A detailed endocrinological assessment, including thyroid ultrasound and scintigraphy, is lacking, as are data on response to treatment and follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aim of this study was to better characterize the thyrotoxicosis secondary to immune checkpoint inhibitors, gaining insights into pathogenesis and treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective study of 20 consecutive patients who had normal thyroid function before starting immunotherapy and then experienced thyrotoxicosis on PD1 or PD-L1 blockade. Clinical assessment was combined with thyroid ultrasound, 99mtechnecium scintiscan, and longitudinal thyroid function tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Five patients had normal or increased scintigraphic uptake (Sci+), no serum antibodies against the thyrotropin receptor, and remained hyperthyroid throughout follow-up. The other 15 patients had no scintigraphic uptake (Sci\u2013) and experienced destructive thyrotoxicosis followed by hypothyroidism (N\u2005=\u20059) or euthyroidism (N\u2005=\u20056). Hypothyroidism was more readily seen in those with normal thyroid volume than in those with goiter (P\u2005=\u2005.04). Among Sci\u2013 individuals, a larger thyroid volume was associated with a longer time to remission (P\u2005&amp;lt;\u2005.05). Methimazole (MMI) was effective only in Sci+ individuals (P\u2005&amp;lt;\u2005.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Administration of PD1- or PD-L1\u2013blocking antibodies may induce 2 different forms of thyrotoxicosis that appear similar in clinical severity at onset: a type 1 characterized by persistent hyperthyroidism that requires treatment with MMI, and a type 2, characterized by destructive and transient thyrotoxicosis that evolves to hypothyroidism or euthyroidism. Thyroid scintigraphy and ultrasound help in differentiating and managing these 2 forms of iatrogenic thyrotoxicosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jendso\/bvab093","type":"journal-article","created":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T03:59:14Z","timestamp":1621051154000},"source":"Crossref","is-referenced-by-count":3,"title":["Management of Thyrotoxicosis Induced by PD1 or PD-L1 Blockade"],"prefix":"10.1210","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5615-6325","authenticated-orcid":false,"given":"Alessandro","family":"Brancatella","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1010-3110","authenticated-orcid":false,"given":"Isabella","family":"Lupi","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Azienda 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Pisa 56126, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Antonangeli","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Sardella","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Brogioni","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Azienda Ospedaliero-Universitaria Pisana, University Hospital of Pisa, Pisa 56124, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2774-9161","authenticated-orcid":false,"given":"Paolo","family":"Piaggi","sequence":"additional","affiliation":[{"name":"Department of 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