Thyroid Strategies for Primary Care-Red Herrings in Thyroid Care

Video Transcription

Video Summary

In the first video, Dr. Carol Spencer discusses the pitfalls in thyroid testing, focusing on technical interferences that can affect the results. She highlights the need for physicians to suspect interference when there is discordance between the test result and the patient's clinical presentation. About 50% of cases of interference have led to inappropriate diagnosis or clinical management. Dr. Spencer explains the vulnerability of endocrine tests to interferences due to their immunometric assay design. She discusses different types of interferences, such as heterophile antibodies and autoantibodies that bind the test analyte. Dr. Spencer advises physicians to work with the laboratory to identify and investigate possible interferences when test results are unexpected.<br /><br />In the second video, the speaker discusses the occurrence of thyroid dysfunction in patients taking checkpoint inhibitors. They explain that there is an upregulation of T-cells expressing the checkpoint in the thyroid of these patients. Certain HLA haplotypes were also found to be shared among patients with thyroid dysfunction. Features of this dysfunction include low FDG uptake on thyroid scans and ultrasound, indicating thyroiditis as the likely cause. The progression from thyrotoxicosis to hypothyroidism appears to be faster compared to typical painless thyroiditis.<br /><br />The speaker mentions that despite the side effects, there may be a silver lining as patients who developed thyroid dysfunction had improved overall survival. Adjusting for various factors, these patients had almost 50% lower risk of dying compared to those who did not develop thyroid dysfunction while on checkpoint inhibitors. The severity of thyroid dysfunction has also been linked to survival in other studies.<br /><br />In conclusion, prompt recognition and management of checkpoint inhibitor-induced thyroid dysfunction are emphasized. The thyroid gland, especially when affected by checkpoint inhibitors, may serve as a model for the development of immunotherapies in the treatment of advanced endocrine cancer.

Keywords

thyroid testing

technical interferences

test result

patient's clinical presentation

endocrine tests

heterophile antibodies

autoantibodies

checkpoint inhibitors

thyroid dysfunction

improved overall survival

immunotherapies