Dynamic follow-up of the effects of programmed death 1 inhibitor treatment on thyroid function and sonographic features in patients with hepatocellular carcinoma

Abstract

Objective: Programmed cell death protein-1 (PD-1) inhibitors are widely u sed for the treatment of hepatocellular carcinoma (HCC). Thyroid dysfunction is common in patients treated with this therapy, although the dynamic changes in thyr oid function and sonographic features remain unclear. Methods: We analyzed 38 patients with HCC who received anti-PD-1 therap y at our hospital. Demographic, clinical, laboratory, and ultrasound data were extracted from electronic medical records. The grading of thyroid nodules was based on the American College of Radiology Thyroid Imaging Reporting and Data System classification. Statistical analyses were performed using GraphPad Prism 5.0. Results: Fifteen patients (40%) had hypothyroidism, among which six had hypothyroidism at baseline, three had overt hypothyroidism, and six had subcli nical hypothyroidism after anti-PD1 therapy. The proportion of patients with euthyro id function and thyroid antibody positivity was significantly lower than that of patient s with thyroid dysfunction (10% vs 39%, P < 0.05). Nine patients (24%) had irregular echo patterns on s onographic imaging, six of whom had irregular echo patterns present during the treatment, but only one had them persist until the end of treatment. At baseline, t he classification of most thyroid nodules was grade 3, with a significant increase in grade 4A and 4B classifications during treatment, though most nodules remained grade 3 at the e nd of treatment. There were no significant differences in survival rates between t he euthyroid and thyroid dysfunction groups. Conclusion: Anti-PD-1 therapy-induced thyroid dysfunction was accompanied by changes in thyroid function, antibodies, and ultrasonography. Therefore, in patients receiving anti-PD-1 therapy, close, dynamic monitoring of thyroid function, antibodies, and ultrasonographic characteristics is necessary.

Keywords

• pd-1
• immunotherapy
• thyroid dysfunction
• ultrasonography