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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Immune-Related Adverse Events for Endocrine Toxicities - Hypothyroidism

    Grades severity of hypothyroidism secondary to immune checkpoint inhibitor therapy.

    INSTRUCTIONS

    Use in adult patients with symptoms of hypothyroidism and/or abnormalities of TSH or free thyroxine level that developed while on treatment with immune checkpoint inhibitors.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with symptoms of hypothyroidism and/or abnormalities of TSH or free thyroxine level that developed while on treatment with immune checkpoint inhibitors, including agents against PD-1 (i.e. pembrolizumab, nivolumab), PD-L1 (i.e. atezolizumab, avelumab, durvalumab), or CTLA-4 (i.e. ipilimumab).

    • Immune checkpoint inhibitor (ICPi) related hypothyroidism should be suspected in patients with TSH, free thyroxine level abnormalities and/or symptoms of hypothyroidism (e.g. extreme tiredness or weakness, weight gain, hair loss, constipation, feeling cold) while on treatment with immune checkpoint inhibitors.

    • May occur any time during immune checkpoint inhibitor treatment.

    • More frequently seen with anti-PD-1 and anti-PD-L1 agents, but also an important adverse event caused by anti-CTLA-4 agents.

    • Management of ICPi related hypothyroidism is based on grade of hypothyroidism.

    This tool aids in the decision to discontinue ICPi, further diagnostic work-up, and thyroid hormone supplementation initiation.

    TSH <10 mIU/L and asymptomatic
    Moderate symptoms; able to perform ADLs; TSH persistently >10 mIU/L
    Severe symptoms, medically significant or life-threatening consequences, unable to perform ADLs

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Julie R. Brahmer

    About the Creator

    Julie R. Brahmer, MSc, MD, is the co-director of the upper aerodigestive department at Johns Hopkins Medicine in Baltimore, MD. She is also a professor of oncology at Johns Hopkins Medicine. Dr. Brahmer’s primary research is focused on treatment of lung cancer and mesothelioma.

    To view Dr. Julie R. Brahmer's publications, visit PubMed

    Are you Dr. Julie R. Brahmer? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Nazli Dizman, MD
    About the Creator
    Dr. Julie R. Brahmer
    Are you Dr. Julie R. Brahmer?
    Content Contributors
    • Nazli Dizman, MD