Anupam Kotwal, Donald S.A. McLeod
Immune checkpoint inhibitors frequently cause thyroiditis mostly as hypothyroidism, either at presentation or preceded by a thyrotoxic phase. Thyroiditis from immune checkpoint inhibitors appears to be T lymphocyte mediated but requires further investigation. Kinase inhibitors may cause direct thyroid dysfunction from vascular injury or increase in levothyroxine metabolism. The high prevalence of thyroid dysfunction after I-131-metaiodobenzylguanidine despite iodine prophylaxis highlights the need for better risk prediction and prophylactic regimens. There appears to be a survival advantage of thyroid dysfunction from immune checkpoint and kinase inhibitors that supports their role as a potential marker for therapeutic efficacy against the malignancy
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