ECE2023 Poster Presentations Thyroid (163 abstracts)
Nivolumab-induced hypothyroidism: a case report
Nagihan Bestepe 1 , Yasar Aydogmus 1 , Belma Tural Balsak 1 , Emre Hafizoglu 2 , Kubra Solmaz 1 , Oya Topaloglu 3 , Reyhan Ersoy 3 & Bekir Cakir 3
1Ankara City Hospital, Endocrinology and Metabolism, Ankara, Turkey; 2Ankara City Hospital, Medical Oncology, Ankara, Turkey; 3Ankara Yildirim Beyazit University Faculty of Medicine, Endocrinology and Metabolism, Ankara, Turkey
Introduction: Immune checkpoint inhibitors are relatively new and promising treatments for a variety of solid tumors. Nivolumab is an anti-cancer monoclonal antibody that inhibits anti-programmed death-1 (PD1) and modulates T-cell response. It has been shown to significantly improve survival in many types of cancer, but clinical studies have also reported an increased risk of developing immune-related adverse events. In particular, immune-related adverse events may be related to the endocrine system. It has been reported that approximately 8% of patients treated with PD-1 inhibitors demonstrate hypothyroidism. We present a case of thyroid dysfunction caused by nivolumab.
Case: A 64-year-old male patient was treated with nivolumab for 10 months for tonsillar squamous cell carcinoma. He had no history of thyroid disease. Laboratory studies performed before the administration of nivolumab revealed normal thyroid function with normal levels of anti-thyroid peroxidase and anti-thyroglobulin antibodies. 9 months after starting treatment, the patient’s thyroid stimulating hormone (TSH) levels suddenly increased to 57.70 mU/l (normal range 0.55–4.78 mU/l). Free T3 level was 1.65 pg/l (normal range 2.3 - 4.2 pg/l) and free T4 level was 0.24 ng/dl (normal range 0.89–1.76 ng/dl). We suspected nivolumab-induced hypothyroidism in the absence of other possible causes and started thyroid hormone replacement. The patient was followed as euthyroid with L-thyroxine 100 mg/day.
Conclusions: Immunotherapy has demonstrated significant clinical efficacy in many types of cancer. Immune checkpoint inhibitors aim to stimulate the immune system against cancer cells but should not be considered independent of some side effects. Thyroid dysfunction should be considered as a possible immune-related adverse event. Therefore, it is important to evaluate thyroid dysfunction at baseline and before the administration of each dose of nivolumab.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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