54例PD-1抑制剂相关甲状腺毒症的临床特征分析

Analysis on the clinical features of 54 patients with PD-1 inhibitor associated thyrotoxicosis

目的:分析程序性死亡受体-1(programmed death-1,PD-1)抑制剂治疗肿瘤所致甲状腺毒症的临床特征以指导临床诊疗。方法:回顾性研究2019年01月至2022年01月在襄阳市中心医院接受PD-1抑制剂治疗后出现甲状腺毒症的患者,分析甲状腺毒症的起始时间、持续时间、临床表现、甲状腺功能恢复正常或出现甲状腺功能减退的时间及T3/T4比值。结果:在610例PD-1抑制剂治疗的肿瘤患者中,54例患甲状腺毒症者纳入研究。出现甲状腺毒症的中位时间为44天,临床上,大部分患者无典型甲状腺相关特异症状。甲状腺毒症持续中位时间为43天。甲状腺毒症期间T3/T4比值中位数为13.8(范围7.8~19.7)ng/μg。结论:PD-1抑制剂导致的甲状腺毒症并不少见,多为破坏性甲状腺炎,临床症状不典型,容易误诊、漏诊,甲状腺ECT和T3/T4比值<20 ng/μg鉴别甲状腺功能亢进和甲状腺炎有意义。

Objective:To analyze the clinical features of programmed death-1(PD-1)inhibitors in the treatment of tumor-induced thyrotoxicosis to guide clinical diagnosis and treatment.Methods:A retrospective study was conducted in patients with thyrotoxicosis after receiving PD-1 inhibitors in Xiangyang Central Hospital from January 2019 to January 2022,and the initiation,duration,clinical manifestations,time when thyroid function returned to normal or hypothyroidism,and T3/T4 ratio were analyzed.Results:Of the 610 oncology patients treated with PD-1 inhibitors,54 cases of patients with thyrotoxicosis were included in the study.The median time to thyrotoxicosis is 44 days,and clinically,most patients do not have typical thyroid-specific symptoms.The median duration of thyrotoxicosis was 43 days.The median T3/T4 ratio during thyrotoxicosis was 13.8(range 7.8 to 19.7)ng/μg.Conclusion:Thyrotoxicosis caused by PD-1 inhibitors is not uncommon,mostly painless thyroiditis,atypical clinical symptoms,easy to misdiagnose and miss,thyroid ECT and T3/T4 ratio less than 20 ng/μg is meaningful for distinguishing hyperthyroidism and thyroiditis.