Thyroid dysfunction following immune reconstitution therapy

Abstract

Medication effects on the immune system often lead to the development of adverse events such as autoimmune diseases. The thyroid gland is organ whose embryonic development features are predisposed spontaneous and induced lesions with various autoimmune effects. Cytokinin-induced thyroiditis (in 5070% of cases proceeds as a destructive thyroiditis), thyroid dysfunction following immune checkpoint inhibitors (using the combined treatment CTLA-4 + PD-1/PD-L1 leads to an increase hypothyroidism rates up to 20%). Some researchers presume that can develop thyroid dysfunction following treatment lithium. Authors emphasize that predisposition to autoimmune mechanisms thyroid diseases also has bipolar affective disorder and treatment with interferon-alfa in hepatitis C. For many of these clinical situations, national and international associations adopted clinical recommendations and physicians have been introduced to optimal screening algorithm of correcting treatment in risk groups. Immune rehabilitation therapy (IRT) is actively used in the treatment of many diseases. The effect of these drugs on the thyroid gland is most fully described for multiple sclerosis, HIV infection and bone marrow transplantation. The peculiarity of the non-specific effect of IRT preparations on the thyroid gland can lead to transient disorders or manifest in the late long-term period after completion of the IRT. This complicates the targeted diagnosis of a whole range of diseases, which means it increases the risk of development and progression of complications, worsens the patients quality of life and prognosis. In this article we reviewed for our readers European clinical guidelines for thyroid dysfunction, following IRT, published in 2019. The recommendations are relevant not only for Endocrinologists, but also for Rheumatologists, Infectious disease specialists, Transplantologists, GP and many other specialties. Earlier, in the Journal of Clinical and Experimental Thyroidology a description was already made for immuno-mediated endocrinopathies, developing in the treatment of cancer patients with inhibitors of immune response control points. These endocrinopathies have their own distinctive features and are of interest in the study of adverse events from the thyroid gland. They are reflected in clinical recommendations and open up new aspects for the Endocrinologists about the effect of modern drugs on the thyroid gland.