irAE Thyrotoxicosis — SCE Medical Oncology MCQ
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Correct answer: D — Manage symptomatically with beta-blockers; continue nivolumab — ICI-related thyrotoxicosis is typically transient destructive thyroiditis that evolves to hypothyroidism
ICI-induced thyrotoxicosis is almost always destructive thyroiditis (not Graves' disease), caused by immune-mediated thyroid cell destruction releasing preformed thyroid hormone. It is self-limiting (typically 3-6 weeks) and evolves into hypothyroidism. Anti-thyroid drugs (carbimazole/methimazole) are ineffective for destructive thyroiditis (they inhibit new hormone synthesis, not hormone release). Management is symptomatic beta-blockers. ICI can be continued for grade 1-2 thyrotoxicosis. TSH monitoring guides levothyroxine initiation when hypothyroidism develops.
Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer