Hypothyroidism after treatment with interleukin-2 and lymphokine-activated killer cells.
The development of a goiter and hypothyroidism in a 28-year-old man in whom metastatic melanoma had been treated with interleukin-2 and lymphokine-activated killer cells (LAK cells) prompted us to assess thyroid function in patients undergoing this therapy. Thirty-four patients with advanced neoplasms who had received interleukin-2 and LAK cells were followed for at least four weeks after treatment. Seven patients (21 percent) had laboratory evidence of hypothyroidism, with a decline in the serum thyroxine concentration to below normal (less than or equal to 35 nmol per liter; normal, 65 to 148), a decline in the serum free thyroxine index, and a rise in the serum thyrotropin concentration (peak values, 7.2 to 166 mU per liter; normal, 0.5 to 5.5) 6 to 11 weeks after treatment. Two patients had elevated serum thyrotropin levels before treatment, which increased further after treatment. In two patients, these abnormal values returned to normal within 10 months. All five symptomatic patients had borderline or elevated serum antimicrosomal antibody titers after treatment; two had serum antibodies to thyroglobulin. Five of the seven patients with hypothyroidism (71 percent) but only 5 of the 27 euthyroid patients (19 percent) had evidence of tumor regression (P less than 0.02). None of 11 patients treated with interleukin-2 but not LAK cells had hypothyroidism. We conclude that treatment with interleukin-2 and LAK cells can cause hypothyroidism, possibly by exacerbating preexisting autoimmune thyroiditis, and that it may be associated with a favorable tumor response.
Atkins
M B
MB
Department of Medicine, New England Medical Center, Boston, MA 02111.
Mier
J W
JW
Parkinson
D R
DR
Gould
J A
JA
Berkman
E M
EM
Kaplan
M M
MM
D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications; D005260:Female; D006042:Goiter / Q000209:etiology; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology*; D007376:Interleukin-2 / Q000009:adverse effects*; D007694:Killer Cells, Natural / Q000276:immunology*; D008222:Lymphokines / Q000276:immunology*; D008297:Male; D009369:Neoplasms / Q000628:therapy; D013966:Thyroiditis / Q000150:complications; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
D007376:Interleukin-2; D008222:Lymphokines; D013972:Thyrotropin; D013974:Thyroxine