Does Vitamin D Status Affect Risk for Thyroid Immune-Related AEs With Immune Checkpoint Inhibitors?

checking thyroid
Shot of senior woman sitting at the doctors office and complaining to her doctor about her tonsil pain while.
Vitamin D status was not linked to risk for thyroid immune-related adverse events in patients initiating immune checkpoint inhibitor therapy.

After careful consideration, the Endocrine Society canceled its annual meeting (ENDO 2020), which was set to take place in San Francisco, California, from March 28 to 31, 2020, because of concerns regarding coronavirus disease 2019 (COVID-19). Research findings that were scheduled to be presented at the meeting have been published in a supplemental issue of the Journal of the Endocrine Society.

The society is hosting ENDO Online, a complimentary virtual event featuring on-demand and live programming, from June 8 to 22, 2020, to provide a platform for continued learning and research exhibition. For more information, visit the Endocrine Society’s website.

Vitamin D deficiency was not found to be associated with an increased risk for thyroid immune-related adverse events (AEs) in patients initiating immune checkpoint inhibitor therapy, according to study findings intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

Although immune checkpoint inhibitors are effective cancer-directed therapies, immune system activation induced by these medications can lead to immune-related AEs that affect the thyroid. Given that vitamin D deficiency has been associated with autoimmune thyroid disease, study investigators hypothesized that being vitamin D deficient when initiating immune checkpoint inhibitor therapy would make patients more likely to experience thyroid immune-related AEs.

Data from 411 patients who received immune checkpoint inhibitors between January 2011 and April 2017 at a single institution were collected. Of these patients, 91 had data for serum 25-hydroxyvitamin D levels available. The researchers excluded 2 individuals from the final sample because of previous thyroidectomy. The remaining 89 patients included for analysis had a mean age of 67.2±10.6 years and 48.3% were women. Most patients were white (57%), 10% were Hispanic, 8% were black, and 7% were Asian.

With regard to cancer type, 20% of patients had non-small cell lung cancer, 15% had melanoma, 13% had hepatocellular carcinoma, 12% had multiple myeloma, 8% had renal cell carcinoma, 7% had urothelial carcinoma, 7% had head and neck squamous cell carcinoma, and 18% had other types of cancer.

Among the 89 patients, 21.3% were vitamin D deficient (<20 ng/mL), 40.4% were insufficient (20-29.9 ng/mL), and 38.2% were sufficient (≥30 ng/mL). Patients who were vitamin D deficient and insufficient were younger (mean ages, 64.1±11.7 and 65.9±9.5 years, respectively) than patients in the vitamin D-sufficient group (mean age, 70.1±10.5 years; P =.046). No significant differences between women and men were observed across vitamin D categories. Vitamin D deficiency was most prevalent in Hispanic and Asian patients (44.4% and 33.3%, respectively). Across the types of cancers, vitamin D deficiency was most prevalent in renal cell carcinoma (42.9%) and multiple myeloma (36.4%).

Overall, 11 patients (12.4%) developed a thyroid immune-related AE. The researchers found no significant difference in rates of immune-related AEs between groups (5.3% in patients with vitamin D deficiency, 8.1% in patients with vitamin D insufficiency, and 20% in patients with vitamin D sufficiency).

The study investigators concluded, “In contrast to our hypothesis, [vitamin D] deficiency was not associated with a higher rate of thyroid [immune-related AEs]. In fact our data suggest that patients who are vitamin D sufficient at the time of starting [immune checkpoint inhibitor] therapy may be at greater risk of developing thyroid [immune-related AEs].” Given the study’s limitations, the study authors recommended that “[p]rospective studies should be performed to determine the significance of [vitamin D] levels on [immune checkpoint inhibitor] related thyroid disease.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Newman SK, Leiter AC, Carroll E, et al. Vitamin D levels and risk of thyroid immune related adverse events in patients on immune checkpoint inhibitors. J Endocr Soc. 2020;4(suppl 1):SAT-411.

Visit Endocrinology Advisor‘s conference section for more coverage from ENDO 2020.