From the Guidelines
Intravenous immunoglobulin (IVIG) therapy can potentially affect thyroid function in some patients, and monitoring thyroid function through blood tests (TSH, T3, T4) before starting treatment and periodically afterward is advisable. The mechanism involves IVIG containing antibodies that can interact with thyroid tissue or affect immune regulation, as seen in various studies 1. Patients with pre-existing thyroid conditions may be more susceptible to these effects. IVIG may cause both hyperthyroidism and hypothyroidism, though these effects are generally temporary and resolve within weeks to months after treatment. Some key points to consider when evaluating the impact of IVIG on thyroid function include:
- The potential for IVIG to cause thyroid dysfunction is a consideration in its use for immune deficiencies, autoimmune disorders, and certain neurological conditions.
- Monitoring thyroid function is crucial, especially for patients with existing thyroid disorders or those experiencing symptoms like fatigue, weight changes, or temperature sensitivity.
- The management of hypothyroidism induced by immune checkpoint inhibitors, as outlined in a 2017 consensus recommendation 1, may provide guidance on how to approach thyroid dysfunction in the context of IVIG therapy, although the specific context of IVIG-induced thyroid issues may differ.
- The effects of IVIG on thyroid function are generally considered side effects rather than primary indications for IVIG therapy. Given the potential for IVIG to impact thyroid function, it is essential to monitor patients receiving IVIG for signs of thyroid dysfunction and to adjust treatment as necessary to minimize adverse effects on morbidity, mortality, and quality of life.
From the Research
Effects of IVIG on Thyroid Function
- The study 2 investigated the relationship between thyroid hormone levels and response to IVIG treatment in patients with Kawasaki disease.
- It found that thyroid hormone levels, including free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH), were low before IVIG treatment and increased significantly after treatment.
- The study suggests that low thyroid hormone levels may be associated with systemic inflammatory conditions, and that IVIG treatment may have an effect on thyroid function in these patients.
Adverse Effects of IVIG
- Other studies 3, 4, 5 have reported on the adverse effects of IVIG, including headache, flushing, fever, chills, fatigue, nausea, diarrhea, blood pressure changes, and tachycardia.
- However, these studies do not specifically address the effect of IVIG on thyroid function.
- The study 6 discusses the implementation of an IVIG stewardship program, which resulted in a decrease in IVIG usage, but does not mention thyroid function.
Thyroid Function and IVIG
- Based on the available evidence, it appears that IVIG may have an effect on thyroid function, particularly in patients with systemic inflammatory conditions such as Kawasaki disease 2.
- However, more research is needed to fully understand the relationship between IVIG and thyroid function.