{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:08:39Z","timestamp":1770750519341,"version":"3.50.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Immunotherapy has revolutionized the treatment of solid malignancies, but is associated with endocrine-related adverse events. This study aims to dissect the natural course of immunotherapy-induced hypothyroidism and provide guidance regarding diagnosis and management in patients with and without pre-existing hypothyroidism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted using patients who received immunotherapy between 2010\u20102019 within a multicenter hospital system. Participants were separated in three groups\u2014those with pre-existing hypothyroidism, those who developed primary hypothyroidism and those with hypophysitis within a year of their first immunotherapy. Serial effects of immunotherapy on thyroid function tests (TFTs) and levothyroxine dosing were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>822 patients were screened, with 85 determined to have pre-existing hypothyroidism, 48 <jats:italic>de-novo<\/jats:italic> primary hypothyroidism and 12 <jats:italic>de-novo<\/jats:italic> hypophysitis. All groups displayed fluctuations in TFTs around weeks 6\u20108 of treatment. In the pre-existing hypothyroidism group, the levothyroxine dose was higher at 54 weeks than at baseline with the difference showing a trend towards statistical significance (p=0.06). The observed mean levothyroxine dose was significantly lower than the mean calculated weight-based dose for all groups. This finding was most clinically significant for the <jats:italic>de-novo<\/jats:italic> hypophysitis group (mean difference: -58.3 mcg, p&amp;lt;0.0001). The mean 0.9 mcg\/kg levothyroxine dose at week 54 for the <jats:italic>de-novo<\/jats:italic> hypophysitis group was statistically lower than the other groups (p=0.009).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It is reasonable to screen with TFTs every 4 weeks, and space out TFTs surveillance to every 12 weeks after week 20. Our findings suggest a more conservative approach for levothyroxine dosing in those developing <jats:italic>de-novo<\/jats:italic> hypothyroidism, especially hypophysitis, such as initiating at 0.9-1.2 mcg\/kg.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2022.798253","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T08:25:19Z","timestamp":1646987119000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Immunotherapy-Associated Hypothyroidism: Comparison of the Pre-Existing With De-Novo Hypothyroidism"],"prefix":"10.3389","volume":"13","author":[{"given":"Megan 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