From the Guidelines
The primary treatment for immunotherapy-induced hyperthyroidism is beta-blocker therapy, specifically propranolol or atenolol/metoprolol, to manage symptoms. According to the most recent and highest quality study 1, in symptomatic hyperthyroidism patients, usually grade 1 or 2, interrupting ICPi and starting beta-blocker therapy is recommended.
Key Considerations
- Beta-blockers, such as propranolol, can be initiated at a dose of 20-40 mg orally three to four times daily to manage symptoms 1.
- Antithyroid medications, such as methimazole, are not recommended as first-line treatment for immunotherapy-induced hyperthyroidism, as the condition is often self-limiting and may lead to permanent hypothyroidism 1.
- Repeat thyroid hormone levels should be performed every 2–3 weeks, and thyroid hormone replacement initiated at the time of hypothyroidism diagnosis 1.
- In rare cases of thyroid storm, hospitalization and more aggressive treatment may be necessary.
Monitoring and Adjustment
- Monitor thyroid function tests every 2-4 weeks and adjust medication doses as needed.
- If severe or persistent, consider temporarily holding immunotherapy.
- Educate patients about symptoms of hyper- and hypothyroidism, as the condition can fluctuate.
- Endocrinology consultation may be beneficial for complex cases. The approach of using beta-blockers to manage symptoms, while carefully monitoring thyroid function and adjusting treatment as needed, helps control symptoms and reduce the risk of complications, ultimately improving morbidity, mortality, and quality of life outcomes for patients with immunotherapy-induced hyperthyroidism 1.
From the FDA Drug Label
Methimazole tablets, USP are indicated: In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. To ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
The treatment for immunotherapy-induced hyperthyroidism (thyrotoxicosis) is not directly addressed in the provided drug labels. However, based on the information provided, methimazole can be used to treat hyperthyroidism.
- The drug labels do not specify the use of methimazole for immunotherapy-induced hyperthyroidism.
- Methimazole is indicated for the treatment of hyperthyroidism in patients with Graves’ disease or toxic multinodular goiter 2. It is essential to consult a healthcare professional for proper diagnosis and treatment of immunotherapy-induced hyperthyroidism.
From the Research
Treatment for Immunotherapy-Induced Hyperthyroidism (Thyrotoxicosis)
- The treatment for immunotherapy-induced hyperthyroidism (thyrotoxicosis) is not directly addressed in the provided studies, but some studies discuss the treatment of hyperthyroidism in general.
- Beta blockers, such as propranolol, are widely used as adjuvant therapy in the treatment of hyperthyroidism 3, 4.
- Beta blockers can improve symptoms such as nervousness, tremor, and tachycardia, and can also reduce the frequency of paralysis in patients with thyrotoxic periodic paralysis 4.
- Radioactive iodine ((131)I) is a common treatment for hyperthyroidism caused by Graves' disease, and a high dose of (131)I therapy can be effective in achieving a euthyroid state 5.
- For patients with immunotherapy-induced hypothyroidism, levothyroxine dosing may need to be adjusted, and a more conservative approach may be necessary, especially in those developing de-novo hypophysitis 6.
- Non-thionamide antithyroid drug options, such as beta blockers, lithium, and glucocorticoids, may be useful alternatives in the treatment of Graves' hyperthyroidism, but more clinical trials are needed to establish their safety and long-term efficacy 7.