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免疫检查点抑制剂相关的甲状腺功能低下症的最佳levothyroxine剂量策略:一项回顾性研究
Ya Gao1, Chunxia Du2, Yan Xu3
1Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
概括
免疫检查点抑制剂 (ICI) 相关的甲状腺功能低下症需要量身定制的勒沃西 (LT4) 剂量. 快速定位策略显著缩短了ICI相关的甲状腺功能低下症患者的甲状腺状态的时间,改善了结果.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 相关的甲状腺功能低下症往往是不可逆转的,需要立即更换甲状腺激素.
- 新辅助免疫疗法强调了对及时甲状腺激素治疗的关键需求.
研究的目的:
- 引入一种新的定位策略,用于ICI相关的甲状腺功能低下症.
- 为了比较不同类型的甲状腺功能低下症子类型的勒沃西 (LT4) 剂量.
- 开发一个预测方程,以获得最佳的LT4剂量.
主要方法:
- 在高等学术医院进行的回顾性研究.
- 涉及109名被诊断患有ICI相关的甲状腺功能低下症的患者.
- 快速与传统的LT4定位策略进行比较.
主要成果:
- 过渡性甲状腺毒性症的患者随后明显的甲状腺功能低下症 (有毒-OHypo) 需要更高的LT4剂量 (平均差异为0.23μg/kg/天).
- 与传统定位相比,快速定位策略显著改善了正常的自由甲状腺素 (FT4) 和甲状腺刺激激素 (TSH) 水平的达到 (HR 4.44和4.11).
- 在Toxic-OHypo中开发了LT4剂量的预测方程:预测的LT4剂量 (μg/kg/day) = (-0.016×体重) + (0.109×基线TSH水平) +2.661.
结论:
- 根据ICI相关的甲状腺功能低下症的特定亚型,Levothyroxine (LT4) 的要求有所不同.
- 快速定位策略有效地缩短了实现euthyroid状态的时间.
- 这种加快方法表明,与传统的LT4疗法相比,其安全性概况相当.
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