Yonezaki Kazuko, Kobayashi Toshihiro, Imachi Hitomi, Yoshimoto Takuo, Kikuchi Fumi, Fukunaga Kensaku, Sato Seisuke, Ibata Tomohiro, Yamaji Nao, Lyu Jingya, Dong Tao, Murao Koji
Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
J Med Case Rep. 2018 Jun 19;12(1):171. doi: 10.1186/s13256-018-1708-x.
Recently, immune checkpoint inhibitors have widely been used for the management of advanced melanoma. However, high-grade immune-related adverse events can occur, particularly with combination immunotherapy. We report a case of a patient with melanoma who developed thyroid storm following treatment with ipilimumab and nivolumab.
An 85-year-old Japanese man with a history of malignant melanoma presented to our department with severe thyrotoxicosis and poor blood glucose control. He was already being treated for Hashimoto's disease and type 2 diabetes mellitus before the treatment for the melanoma. During admission, laboratory investigations revealed the following thyroid functions: thyroid-stimulating hormone below sensitivity, free triiodothyronine 31.7 pg/ml, and thyroglobulin 48,000 IU/ml. Thyroid-stimulating hormone receptor antibody was negative, and a Tc-labeled thyroid scan revealed a markedly decreased uptake. He was treated with beta-blocker, orally administered potassium iodine, a relatively low dose of prednisolone, and insulin injection therapy to control his blood glucose, resulting in an improvement in thyroid function and his symptoms.
It might be important to be aware of the possibility of thyroid storm induced by immune checkpoint inhibitors.
最近，免疫检查点抑制剂已广泛用于晚期黑色素瘤的治疗。然而，可能会发生高级别免疫相关不良事件，尤其是联合免疫治疗时。我们报告一例黑色素瘤患者在接受伊匹木单抗和纳武单抗治疗后发生甲状腺风暴的病例。
一名85岁有恶性黑色素瘤病史的日本男性因严重甲状腺毒症和血糖控制不佳前来我科就诊。在黑色素瘤治疗前，他已在接受桥本氏病和2型糖尿病的治疗。入院期间，实验室检查显示以下甲状腺功能：促甲状腺激素低于检测下限，游离三碘甲状腺原氨酸31.7 pg/ml，甲状腺球蛋白48,000 IU/ml。促甲状腺激素受体抗体为阴性，锝标记甲状腺扫描显示摄取明显降低。给予他β受体阻滞剂、口服碘化钾、相对低剂量的泼尼松龙以及胰岛素注射治疗以控制血糖，甲状腺功能和症状均得到改善。
认识到免疫检查点抑制剂诱发甲状腺风暴的可能性可能很重要。
