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Endocrine Abstracts (2017) 49 EP772 | DOI: 10.1530/endoabs.49.EP772

Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.


Introduction: Immune checkpoint inhibitors (ICPIs) are recent approved drugs used in malignant melanoma, non-small-cell lung cancer and renal cell cancer. They act by activating host T cell against malignant antigens. Immune checkpoint blockade can lead to breaking of immune self-tolerance, thereby inducing autoimmune/autoinflammatory side effects, such as endocrinopathies. It may affect thyroid, adrenal and pituitary. We present two ICPIs induced thyroiditis cases.

Case 1: Sixty-eight-year-old female diagnosed with a conjunctival malignant melanoma at the age of 64. She was first surgery treated and then submitted to radiotherapy. Due to bone, lung and hepatic metastasis she started Ipilimumab 3 mg/kg on 21-day cycle. Eleven days after the third Ipilimumab administration she was asymptomatic but was found to have thyrotoxicosis (TSH 0.04 μUI/ml; FT4 1.31 ng/dl). Thyroid peroxidase and thyroglobulin antibodies were elevated and thyroid stimulating immunoglobulin was low. Four months after suspension of Ipilimumab a spontaneous recovery of the thyroid axis was seen.

Case 2: Sixty-two-year-old female diagnosed with a foot malignant melanoma one year before. She was first surgically treated. Due to lung, breast and lymph node metastases she started Nivolumab 3 mg/kg on 15-day cycle. Before starting this drug she had a diffuse thyroid uptake on PET-scan with normal thyroid function. Twelve days after the first administration of Nivolumab she described a painless increase of anterior cervical volume, fatigue and had thyrotoxicosis on the blood test (TSH 0.02 μUI/ml; FT4 2.50 ng/dl). One month after she was found to have asymptomatic hypothyroidism (TSH 9.96 μUI/ml; FT4 0.49 ng/dl). Thyroid ultrasound showed a thyroiditis pattern. She started levothyroxine therapy and one month after stopping Nivolumab she was still on hypothyroidism.

Conclusions: ICI may induce autoimmune thyroiditis or may worsen a pre-existing one. These patients should be monitored for signs and symptoms of thyroid dysfunction, since it can cause significant morbidity if not promptly recognized and treated.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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