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Xu T, Guo W, Ren Z, Wei H, Tan L, Zhang W. Study on the Relationship Between Serum Iodine and Thyroid Dysfunctions: a Cross-Sectional Study. Biol Trace Elem Res 2023; 201:3613-3625. [PMID: 36319829 DOI: 10.1007/s12011-022-03459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/20/2022] [Indexed: 04/17/2023]
Abstract
The relationship between serum iodine (SIC) and thyroid dysfunctions in adults is poorly understood, and this study aimed to explore their relationship. A total of 1320 participants were included in the final analysis. We collected basic demographic information, blood, and spot urine samples to determine serological indices and iodine nutritional status. The median (IQR) of urinary iodine (UIC)/urinary creatinine (UCr), UIC, SIC were 138.1 (91.1, 207.6) μg/g, 155.8 (94.5, 211.1) μg/L, and 70.6 (59.8, 83.9) μg/L, respectively. The 90% reference ranges for UIC/UCr and SIC were 66.5-349.8 mg/g and 49.3-97.1 μg/L. SIC was positively correlated with UIC and UIC/UCr. The prevalence of overt hypothyroidism and subclinical hypothyroidism in female was significantly higher than that in male (P = 0.02, P = 0.002). In male, subjects above the upper reference value of SIC (97.1 μg/L) had a higher risk of subclinical hyperthyroidism (OR = 4.46, 95% CI: 1.29, 12.8) and overt hypothyroidism (OR = 5.59, 95% CI: 1.88, 6.42). In female, subjects below the lower reference value of SIC (49.3 μg/L) had a higher risk of overt hypothyroidism (OR = 2.18, 95% CI: 1.10, 4.06), TgAb positive (OR = 1.97, 95% CI: 1.15, 3.32) and TPOAb positive (OR = 2.48, 95% CI: 1.41, 4.26). In conclusion, serum iodine can be used as an indicator to evaluate iodine nutritional status and thyroid dysfunctions. Higher serum iodine concentration was associated with an increased risk of subclinical hyperthyroidism and overt hypothyroidism in men; lower serum iodine concentration was associated with an increased risk of overt hypothyroidism and positive TgAb and TPOAb in women.
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Affiliation(s)
- Tingting Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhiyuan Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongyan Wei
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research On Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China.
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China.
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research On Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China.
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Mazarico I, Capel I, Giménez-Palop O, Albert L, Berges I, Luchtenberg F, García Y, Fernández-Morales LA, De Pedro VJ, Caixàs A, Rigla M. Low frequency of positive antithyroid antibodies is observed in patients with thyroid dysfunction related to immune check point inhibitors. J Endocrinol Invest 2019; 42:1443-1450. [PMID: 31093955 DOI: 10.1007/s40618-019-01058-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/07/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICI), such as programmed death-1 inhibitors (anti-PD1), have become a cornerstone for the treatment of different advanced cancers. These antibodies act as modulators of immune checkpoint proteins. However, ICI can lead to the breaking of immune self-tolerance, inducing autoimmune side effects (irAEs), including endocrinopathies. One of the most frequent endocrine irAE of anti-PD1 is thyroid dysfunction, but the exact mechanism of this disease still remains unknown. MATERIALS AND METHODS We conducted a descriptive retrospective study, analyzing 11 patients who received at least one dose of anti-PD1 (nivolumab or pembrolizumab) and presented thyroid irAEs. Data were collected between September 2015 and May 2018 in our hospital. The aim was to analyze the clinically relevant features of thyroid irAEs and the frequency of antithyroid antibodies (ATA) positivity observed on them. RESULTS AND DISCUSSION 8 of the 11 patients were treated with nivolumab and the other three patients received pembrolizumab. Six patients presented silent thyroiditis with a thyrotoxicosis phase; three patients developed directly primary/subclinical hypothyroidism and two patients showed primary hyperthyroidism. Thyroid autoantibodies (anti-Thyroglobulin and anti-Thyroid Peroxidase) were assessed in all the 11 patients, and only in two of them (18%) a positive titer was displayed. Anti-TSH receptor antibodies (TRAbs) were examined in five patients, three with painless thyroiditis at the time of thyrotoxicosis and two with primary hyperthyroidism, and they all had undetectable levels. CONCLUSIONS In our sample of 11 Caucasian patients with thyroid dysfunction related with anti-PD1, we found low frequency of ATA positive titers, comparable to other recent reports in others ethnicities, which could suggest that silent thyroiditis due to pembrolizumab or nivolumab has a different pathogenesis from the classical autoimmune spontaneous thyroiditis. Further investigations are required to completely understand the immune mechanisms involved.
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Affiliation(s)
- I Mazarico
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
| | - I Capel
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - O Giménez-Palop
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - L Albert
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - I Berges
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - F Luchtenberg
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - Y García
- Oncology Department. Parc, Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Sabadell, Spain
| | - L A Fernández-Morales
- Oncology Department. Parc, Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Sabadell, Spain
| | - V J De Pedro
- Pharmacy Department. Parc, Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Sabadell, Spain
| | - A Caixàs
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Rigla
- Endocrinology and Nutrition Department, Parc Taulí University Hospital, Institut d'Investigació i Innovació ParcTaulí (I3PT), UAB, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
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Takeno A, Yamamoto M, Morita M, Tanaka S, Kanazawa I, Yamauchi M, Kaneko S, Sugimoto T. Late-onset isolated adrenocorticotropic hormone deficiency caused by nivolumab: a case report. BMC Endocr Disord 2019; 19:25. [PMID: 30782163 PMCID: PMC6381704 DOI: 10.1186/s12902-019-0335-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors including nivolumab, an anti-programmed cell death protein 1 antibody, are recently developed cancer immunotherapy agents. Immune checkpoint inhibitors are known to cause autoimmune-related side effects including endocrine dysfunctions. However, there are few reports on late-onset isolated adrenocorticotropic hormone (ACTH) deficiency caused by nivolumab. CASE PRESENTATION The patient was a 72-year-old female. When she was 64 years old, she was diagnosed with malignant melanoma of the left thigh accompanied by left inguinal lymph node metastases, and she received several courses of chemotherapy for malignant melanoma followed by the resection of these lesions. At 71 years of age, multiple metastases were found and treatment with nivolumab 2 mg/kg every 3 weeks was initiated. Six months later, replacement with levothyroxine was started because of hypothyroidism following mild transient thyrotoxicosis. Eleven months after the beginning of nivolumab, the treatment was discontinued because of tumor expansion. Four months after the discontinuation of nivolumab, general malaise and appetite loss worsened, and 2 months later, hyponatremia (Na; 120-127 mEq/L) and hypoglycemia (fasting plasma glucose; 62 mg/dL) appeared. Her ACTH and cortisol levels were extremely low (ACTH; 9.6 pg/mL, cortisol; undetectable). Challenge tests for anterior pituitary hormones showed that responses of ACTH and cortisol secretion to corticotropin-releasing hormone were disappeared, although responses of other anterior pituitary hormones were preserved. Thus, she was diagnosed with isolated ACTH deficiency. Her symptoms were improved after treatment with hydrocortisone. CONCLUSIONS The present report showed a case of late-onset isolated ACTH deficiency accompanied by hyponatremia, which was diagnosed 6 months after the discontinuation of nivolumab. The effects of nivolumab last for a long time and the side effects of nivolumab can also appear several months after discontinuation of the drug. Repeated monitoring of serum sodium levels may be a beneficial strategy to find the unexpected development of adrenal insufficiency even after discontinuation of nivolumab.
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Affiliation(s)
- Ayumu Takeno
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Masahiro Yamamoto
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Miwa Morita
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Sayuri Tanaka
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Ippei Kanazawa
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Mika Yamauchi
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Sakae Kaneko
- Department of Dermatology, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
| | - Toshitsugu Sugimoto
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane 693-8501 Japan
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Chalan P, Di Dalmazi G, Pani F, De Remigis A, Corsello A, Caturegli P. Thyroid dysfunctions secondary to cancer immunotherapy. J Endocrinol Invest 2018; 41:625-638. [PMID: 29238906 PMCID: PMC5953760 DOI: 10.1007/s40618-017-0778-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/21/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Immunotherapy is a firmly established pillar in the treatment of cancer, alongside the traditional approaches of surgery, radiotherapy, and chemotherapy. Like every treatment, also cancer immunotherapy causes a diverse spectrum of side effects, collectively referred to as immune-related adverse events. OBJECTIVE This review will examine the main forms of immunotherapy, the proposed mechanism(s) of action, and the incidence of thyroid dysfunctions. METHODS A comprehensive MEDLINE search was performed for articles published up to March 30, 2017. RESULTS Following the pioneering efforts with administration of cytokines such as IL-2 and IFN-g, which caused a broad spectrum of thyroid dysfunctions (ranging in incidence from 1 to 50%), current cancer immunotherapy strategies comprise immune checkpoint inhibitors, oncolytic viruses, adoptive T-cell transfer, and cancer vaccines. Oncolytic viruses, adoptive T-cell transfer, and cancer vaccines cause thyroid dysfunctions only rarely. In contrast, immune checkpoint blockers (such as anti-CTLA-4, anti-PD-1, anti-PD-L1) are associated with a high risk of thyroid autoimmunity. This risk is highest for anti-PD-1 and increases further when a combination of checkpoint inhibitors is used. CONCLUSIONS Cancer patients treated with monoclonal antibodies that block immune checkpoint inhibitors are at risk of developing thyroid dysfunctions. Their thyroid status should be assessed at baseline and periodically after initiation of the immunotherapy.
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Affiliation(s)
- P Chalan
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Building-Room 656, 720 Rutland Avenue, Baltimore, MD, 21205, USA
| | - G Di Dalmazi
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Building-Room 656, 720 Rutland Avenue, Baltimore, MD, 21205, USA
- Division of Endocrinology, Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - F Pani
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Building-Room 656, 720 Rutland Avenue, Baltimore, MD, 21205, USA
- Endocrinology Unit, Department of Medical Sciences and Public Health Endocrinology, University of Cagliari, Cagliari, Italy
| | - A De Remigis
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Building-Room 656, 720 Rutland Avenue, Baltimore, MD, 21205, USA
- Department of Medicine, Arco Hospital, Trento, Italy
| | - A Corsello
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Building-Room 656, 720 Rutland Avenue, Baltimore, MD, 21205, USA
- Endocrine Tumor Unit, Department of General Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - P Caturegli
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Building-Room 656, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
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