Immuntherapie mit Checkpointinhibitoren und schilddrüsentypische Komplikationen

Zusammenfassung

Die Therapie mit Immuncheckpointinhibitoren findet in den letzten Jahren zunehmend Anwendung bei der Therapie einer Vielzahl onkologischer Erkrankungen. Schilddrüsenfunktionsstörungen stellen eine der häufigsten unerwünschten Nebenwirkungen unter diesen Therapien dar. Initial kommt es häufig zu einer transienten, zerfallsbedingten Hyperthyreose, die dann in eine Hypothyreose übergeht. Der genaue pathophysiologische Mechanismus ist jedoch noch nicht hinreichend geklärt. Die Verläufe können asymptomatisch sein; nicht selten kommt es jedoch zu hyper- und hypothyreosetypischen Symptomen, die unter Umständen erst spät einer Schilddrüsenfunktionsstörung zugeordnet werden, da diese letztlich unspezifisch und auch im Rahmen der onkologischen Grunderkrankung denkbar sind. Daher ist bei Verdacht auf das Vorliegen eine fachspezifische Vorstellung beim Nuklearmediziner wichtig zur gezielten Diagnostik mittels Anamnese, Labor, Sonografie und ggf. auch Szintigrafie um weitere Differenzialdiagnosen auszuschließen. Bei Auftreten einer Hyperthyreose steht die symptomatische Therapie im Vordergrund; der Einsatz von Thyreostatika ist nur eingeschränkt zu empfehlen. Eine Hypothyreose sollte mit einer an den TSH-Wert und die Klinik angepassten Schilddrüsenhormonsubstitution therapiert werden. Bis ein stabiler Zustand erreicht ist, sollten dem Krankheitsverlauf angepasste fachspezifische Vorstellungen erfolgen. Im Regelfall kann die Immuntherapie ohne Unterbrechung fortgeführt werden.

Abstract

Therapy with immune checkpoint inhibitors has been increasingly used in recent years for many different tumor entities. Thyroid dysfunction is one of the most common adverse effects of these therapies. Initially, transient, decay-related hyperthyroidism often occurs, which then progresses to hypothyroidism. However, the exact pathophysiological mechanism is not yet sufficiently clarified. Courses can be asymptomatic. However, it is not uncommon for typical symptoms of hyperthyroidism and hypothyroidism to appear, which possibly can only be attributed to a thyroid dysfunction at a late stage, since these are at last non-specific and also conceivable in the context of the oncological underlying disease. Therefore, if there is a suspicion of the presence, the consultation of a nuclear medicine doctor is important for targeted diagnostics using anamnesis, laboratory, sonography and, if necessary, also scintigraphy in order to rule out further differential diagnoses. If hyperthyroidism occurs, the focus is on symptomatic therapy; the use of antithyroid drugs is only recommended to a limited extent. Hypothyroidism should be treated with thyroid hormone substitution adapted to the TSH value and the clinical condition. Until a stable condition is reached, subject-specific presentations adapted to the course of the disease should be made. Usually the immunotherapy can be continued without interruption.

Schlüsselwörter

Checkpoint-Inhibitoren - Immune-related adverse effects - Schilddrüsenfunktionsstörungen - Autoimmunthyreoiditis

Keywords

Checkpoint inhibitors - immune-related adverse effects - thyroid dysfunction - autoimmune thyroiditis

Publication History

Article published online:
01 March 2024

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