Health

What thyroid disorders should be considered when TSH is suppressed and thyroid hormone levels are normal or elevated in the setting of ICPI therapy? Suppressed serum TSH levels with normal or elevated thyroid hormone values would suggest autoimmune hyperthyroidism (Graves’ disease) or the hyperthyroid phase of destructive thyroiditis. Patients with autoimmune hyperthyroidism often have a …

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What is the differential diagnosis for an elevated serum thyroid-stimulating hormone (TSH) and a normal or low serum free T 4 in the setting of ICPI therapy? Primary hypothyroidism should be suspected in the setting of an elevated serum TSH level with a normal or low serum free T 4 value; however, this thyroid test pattern can also be …

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What thyroid disorders are associated with the use of ICPIs? How are they differentiated, and how are they managed? A recent study reported that approximately 30% of patients on ICPIs had new-onset of thyroid function abnormalities, and an additional 70% with preexisting thyroid disorders had exacerbations appear on laboratory testing at a median time point …

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What is the management for ICPI related hypophysitis? There is some controversy regarding the optimal management of ICPI-related hypophysitis. Patients with central adrenal insufficiency should be treated with corticosteroids promptly and prior to other replacement hormones, especially thyroid hormone because initial treatment with thyroid hormone may precipitate an adrenal crisis in patients with coexisting impairment …

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What previously rare pituitary problem is seen with ICPIs? Which medication is it most commonly associated with? How does it present clinically? Hypophysitis or inflammation of the pituitary gland and stalk leading to pituitary dysfunction is seen relatively frequently with certain ICPIs. Common symptoms of hypophysitis include headache, weakness, and fatigue. Imaging often shows pituitary …

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How are organ specific toxicities caused by immunotherapies graded? The National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) is a descriptive terminology used for adverse event (AE) reporting. A grade refers to the severity of an AE and a general guideline is used to grade AEs on a scale of 1 through …

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What specific endocrine disorders are seen with ICPIs? The most common endocrinopathies associated with ICPIs are acute hypophysitis (with accompanying central adrenal insufficiency, central hypothyroidism, and hypogonadotropic hypogonadism), and thyroid dysfunction. Additional endocrinopathies can include primary adrenal insufficiency, type 1 diabetes mellitus, and hypoparathyroidism, although these are much less common. The risk for development of …

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