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Objective To investigate the clinical characters and influence factors of immune-related thyroiditis(irT) brought by the immune checkpoint inhibitors (ICI) in treatment of malignant tumor. Methods The clinical data were retrospectively analyzed of 286 certificated patients treated with ICI in the Department of Oncology, the First Medical Center of Chinese PLA General Hospital during 2019-2020. The patients were divided into irT group (n=83) and non-irT group (n=203)according to the occurrence of thyroid dysfunction, and the differences between the two groups were compared of age, gender,tumor origin, previous treatment history and ICI types. Then the patients were divided into different subgroups according to the clinical manifestations or severity of irT, then the time of thyroid injury occurrence, auto-antibody level and recovery degree of thyroid dysfunction were compared and analyzed among different subgroups. Results Of the 286 certificated patients, 83 patients(29.0%) developed irT, those with lower age and history of radiotherapy had greater incidence rate. The clinical manifestation of irT included hyperthyroidism (n=28, 33.7%), hypothyroidism (n=48, 57.8%) and transient thyroiditis with normal thyroid function(n=7, 8.4%). All the 83 irT patients, 76 patients (91.6%) only developed mild irT, while 7 patients (8.4%) were severe. In the 28 patients initially diagnosed as immune-related hyperthyroidism, 7 patients (25%) progressed to secondary hypothyroidism in the later course with faster evolution rate than the patients with primary thyroiditis. There was no statistical difference in irT incidence among the patients treated with 4 frequently used PD-1 inhibitors (Pembrolizumab, Nivolumab, Sintilimab and Toripalimab).Among the 83 irT patients, the serum thyroid auto-antibodies levels were often elevated in irT patients. The thyroglobulin antibody(TGAb) was elevated in 23 patients (29.5%) and the thyroid peroxidase antibody (TPOAb) were elevated in 14 patients (12.8%).The TGAb and TPOAb levels were significantly higher in severe irT patients than that in mild patients. The symptoms in most irT patients were reversible and the treatment was tolerable. Only 3 patients (3.6%) stopped ICI treatment due to intolerable symptoms. Conclusions The incidence of irT during immunotherapy was relatively high and its clinical manifestations progressed rapidly.Continuously monitoring the thyroid function should be done during ICI treatment. The clinicians should treat the irT patients promptly according to their clinical stages and symptoms.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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