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Hematology and Oncology · Endocrinology

Immune-Related Primary Hypothyroidism Grade calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

TSH is elevated above the laboratory reference

The table defines primary hypothyroidism as elevated TSH. It does not print the laboratory reference, only the 10 mIU/L cut.

Free T4 is normal or low
mIU/L

Allowed range: 0–200 mIU/L

Quick picks

Grade 1 is TSH below 10 mIU/L. Grade 2 is TSH persistently above 10 mIU/L. Exactly 10 mIU/L sits in neither printed inequality when symptoms are absent.

Symptoms of hypothyroidism
Unable to perform activities of daily living
Life-threatening consequences

Result

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Clinical inputs

  • TSH is elevated above the laboratory reference
  • Free T4 is normal or low
  • TSH (mIU/L)Accepted range: 0 to 200
  • Symptoms of hypothyroidism
  • Unable to perform activities of daily living
  • Life-threatening consequences

Primary source

Brahmer JR et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. PMID: 29442540. Table 4, section 4.1.1 Primary hypothyroidism. Definition: elevated TSH with normal or low free T4. Grade 1: TSH below 10 mIU/L and asymptomatic. Grade 2: moderate symptoms, able to perform activities of daily living, or TSH persistently above 10 mIU/L. Grade 3 to 4, one printed row: severe symptoms, medically significant or life-threatening consequences, unable to perform activities of daily living. That combined row is returned as 3. TSH of exactly 10 mIU/L is inside neither printed inequality. When symptoms are absent, the result is -1. That number is not grade 1 and not grade 2. Its label says the printed cutoffs do not assign TSH of exactly 10 mIU/L when symptoms are absent. TSH of 9.9 mIU/L without symptoms stays grade 1. TSH of 10.1 mIU/L without symptoms is grade 2. Moderate symptoms remain grade 2. If TSH is not elevated or free T4 is not normal or low, the definition is not met and the result is 0. When more than one printed finding is present, the higher grade is returned. Management text from the table is not used. (2018)

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