Endocrine Hypothyroidism
May 17, 2025Endocrine Diabetes Mellitus
May 18, 2025Endocrine
Hyperthyroidism
Low TSH and increased fT4 and/or fT3
Hyperthyroidism related to ICPI is generally transient and followed by hypothyroidism where adequate substitution is indicated.
Therefore, antithyroid drugs are not required.
Asymptomatic
Management
- Pursue ICPI
-No treatment
Assessment and Investigations
- Repeat thyroid function tests
- Medication history: amiodarone or lithium therapy
Symptomatic
-
Increased TSH with low free T4
Management
Pursue ICPI
- In the hyperthyroid phase, patients may benefit from beta blockers if symptomatic (e.g., atenolol 25-50 mg daily, titrate for HR < 90 if BP allows). Monitor closely with regular symptom evaluation and fT4 testing every 2 weeks
- Introduce thyroid hormones (see hypothyroidism management) if the patient becomes hypothyroid (low T4/T3, even if TSH is not elevated)
- In the hyperthyroid phase, patients may benefit from beta blockers if symptomatic (e.g., atenolol 25-50 mg daily, titrate for HR < 90 if BP allows). Monitor closely with regular symptom evaluation and fT4 testing every 2 weeks
- Introduce thyroid hormones (see hypothyroidism management) if the patient becomes hypothyroid (low T4/T3, even if TSH is not elevated)
Assessment and Investigations
- Thyroid function tests (fT3, fT4, TSH)
- Anti-TPO, TSI
- Thyroid echography (nodule?)
- Medication history: amiodarone or lithium therapy
- Suspect Graves’ disease if :
- – pretreatment by anti-CTLA-4
- – persistant hyperthyroidism beyond 6 weeks
Severe
Management
- Hold ICPi, restart when downgraded to grade 2
- Treat same as grade 2 – Symptomatic
- Discuss with endocrinologist See 'Hyperthyroidism - Symptomatic'