Work

Immune Checkpoint Inhibitors and Hypothyroidism: An Emerging Public Health Challenge Identified Through a Systematic Review of ClinicalTrials.gov

Year: 2026

Type: review

Abstract: Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, but their growing use has exposed a class of immune-related side effects with lasting consequences, most notably hypothyroidism. Unlike many other drug-related toxicities, ICI-associated hypothyroidism is frequently permanent, requiring lifelong thyroid hormone replacement. As the number of long-term cancer survivors continues to rise, this condition is an underrepresented public health problem. This study aimed to characterize how often hypothyroidism is reported as an adverse event (AE) across ICI clinical trials using publicly available data from ClinicalTrials.gov and to examine the public health implications of these findings. We expected hypothyroidism to be common, particularly with programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors and combination regimens, and that registry-reported frequencies would be high enough to justify wider surveillance beyond individual clinical care. Using a PRISMA 2020-aligned registry-based systematic review, we screened interventional oncology trials with posted results and extracted thyroid-related AE data for descriptive analysis. Across eligible trials, hypothyroidism was consistently reported, with trial-reported proportions ranging from low single digits to over 30%, with the highest frequencies seen in combination ICI regimens. These findings demonstrate that ICI-associated hypothyroidism is frequently reported across clinical trials and support the need for standardized thyroid monitoring, long-term endocrine follow-up, and integration of thyroid toxicity surveillance into survivorship care and health system planning.

Source: Cureus

DOI: 10.7759/cureus.117019

Authors: Jeffrey Wu, Xuetao Wu, Hong Ren

Institutions: University of Massachusetts Amherst, Virginia Mason Medical Center, Virginia Mason Federal Way Medical Center

Language: English

Topic: Cancer Immunotherapy and Biomarkers

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: Massachusetts General Hospital