Hyperthyroidism related to immune checkpoint therapy is generally transient and followed by a phase of hypothyroidism where adequate subsitition is indicated. Therefore no causative treatment with antithyroid drugs is indicated. Note: High dose corticosteroids (1 mg/kg/day) are not routinely required

Symptom Grade

Grade 1

Asymptomatic; clinical or diagnostic observations only intervention not indicated;

Grade 2

Symptomatic; thyroid suppression therapy indicated; limiting instrumental ADL

Grade 3

Severe symptoms; limiting self-care ADL; hospitalization indicated

Grade 4

Life-threatening consequences; urgent intervention indicated

Management escalation pathway

Persue ICPI

In the hyperthyroid phase, patients may benefit from beta blockers if symptomatic (e.g., atenolol 25–50 mg daily, titrate for HR < 90 if BP allows). Monitor closely with regular symptom evaluation and free T4 testing every 2 weeks

Introduce thyroid hormones (see hypothyroidism management) if the patient becomes hypothyroid (low T4/T3, even if TSH is not elevated)

Graves’ disease should be treated per standard guidelines.

Hold ICPI for ≥ grade 3 irAEs

same as grade 2

Repeat control
– In form patient of risks 
– Autoimmune serology:
– Anti-thyreoglobuline
– Anti-thyreoperoxidase
– TSI (thyroid stimulating immunoglobulins)
– Thyroid echography (if nodules present they should be further explored)
– Medication history: amiodarone or lithium therapy