As immune checkpoint inhibitor drugs are being used in the treatment of some cancers, unusual adverse events are being reported, labeled as immune-related adverse events. Various endocrinopathies related to immune-related adverse events have been described, among which hypoparathyroidism is exceedingly rare. We report a case of hypoparathyroidism induced by immune checkpoint drugs, highlighting the need for awareness of this emerging complication.

Background and objectives: It is unclear why many patients with hypothyroidism prefer the use of desiccated thyroid extract (DTE) as a thyroid hormone replacement formulation over levothyroxine (LT4) treatment, as recommended by clinical practice guidelines. We analyzed patient-reported information from patient online forums to better understand patient preferences for and attitudes toward the use of DTE to treat hypothyroidism. Materials and Methods: We conducted a mixed-methods study by evaluating the content of online posts from three popular hypothyroidism forums from patients currently taking DTE (n = 673). From these posts, we extracted descriptive information on patient demographics and clinical characteristics and qualitatively analyzed posts’ content to explore patient perceptions on DTE and other therapies further. Results: Nearly half (46%) of the patients reported that a clinician initially drove their interest in trying DTE. Patients described many reasons for switching from a previous therapeutic approach to DTE, including lack of improvement in hypothyroidism-related symptoms (58%) and the development of side effects (22%). The majority of patients described DTE as moderately to majorly effective overall (81%) and more effective than the previous therapy (77%). The most frequently described benefits associated with DTE use were an improvement in symptoms (56%) and a change in overall well-being (34%). One-fifth of patients described side effects related to the use of DTE. Qualitative analysis of posts’ content supported these findings and raised additional issues around the need for individualizing therapy approaches for hypothyroidism (e.g., a sense of each patient has different needs), as well as difficulties obtaining DTE (e.g., issues with pharmacy availability). Conclusions: Lack of individualized treatment and a feeling of not been listened to were recurrent themes among DTE users. A subset of patients may prefer DTE to LT4 for many reasons, including perceived better effectiveness and improved overall well-being, despite the risks associated with DTE.

Background: The frequency and factors associated with thyroid hormone replacement therapy among patients with subclinical hypothyroidism remains uncertain. Methods: In this electronic health records-based observational cohort study, we included adults diagnosed with subclinical hypothyroidism from four academic centers (United States of America and Mexico) from 01/01/2016 to 12/31/2018). We aimed to identify the determinants of thyroid hormone replacement therapy for subclinical hypothyroidism and the frequency of treated subclinical hypothyroidism. Results: A total of 796 patients (65.2% women) had subclinical hypothyroidism, and 165 (20.7%) were treated with thyroid hormone replacement therapy. The treated group was younger [51.0 (SD 18.3) vs. 55.3 (SD 18.2) years, P= .008] and had a higher proportion of women (72.7% vs. 63.2%, P= .03) compared to the untreated group. Only 46.7% of patients in the treated group and 65.6% in the untreated group had confirmatory thyroid function tests before the decision to start thyroid hormone replacement therapy was made. There was no difference in the frequency of thyroid autoimmunity evaluation, but a positive thyroid autoimmunity test was more frequent in the treated group compared to the untreated group (48.2% vs. 20.3%, P= <.001). In a multivariable logistic regression model, female sex (OR=1.71, 95% CI 1.13 to 2.59, P= .01) and index thyrotropin level (OR=1.97, 95% CI 1.56 to 2.49, P= <.001 for every SD (2.75 mIU/L) change) were associated with higher odds of treatment. Conclusions: Among patients with subclinical hypothyroidism, female sex, and index thyrotropin level were associated with higher odds of treatment. Moreover, in our population, the decision to treat or not to treat subclinical hypothyroidism was often based on only one set of abnormal thyroid function tests, and thyroid autoimmunity assessment was underused.