Kawagishi Sachi, Kimura Toru, Kimura Kenji, Fukui Eriko, Kanou Takashi, Ose Naoko, Shintani Yasushi
Department of General Thoracic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0104. Epub 2025 May 28.
The use of immune checkpoint inhibitors (ICIs) as neoadjuvant therapies for locally advanced and resectable non-small cell lung cancer is increasing. As a result, immune-related adverse events (irAEs) may be observed before surgery and may require preoperative intervention. We report the case of a patient with destructive thyroiditis induced by neoadjuvant ICI treatment, in which surgical resection was performed after steroid treatment.
A 74-year-old woman was diagnosed with slow-growing squamous cell carcinoma of the right upper lobe during treatment for another disease. Imaging studies revealed a small nodule suggestive of pulmonary metastasis in the right upper lobe and hilar lymph node metastasis. The patient was initially diagnosed with primary lung cancer of the right upper lobe (cT3N1M0, Stage IIIA, TNM Classification, 8th edition), and neoadjuvant nivolumab combined with chemotherapy was planned every 3 weeks for three cycles. After the first cycle, the patient experienced drug-induced kidney injury. Nivolumab and chemotherapy were discontinued, and surgical resection was planned. However, a laboratory analysis on the day before surgery revealed elevated free triiodothyronine and free thyroxine, and decreased thyroid-stimulating hormone. Subsequent examination led to a diagnosis of destructive thyroiditis due to irAEs, and surgery was postponed. Dexamethasone was administered orally for 1 week, and once the thyroid function showed consistent improvement, a thoracoscopic right upper lobectomy was performed. The patient progressed without any other complications after surgery.
This report highlights a case of preoperative destructive thyroiditis secondary to irAEs. In patients receiving preoperative ICIs therapy, routine blood tests, including thyroid function tests, are recommended as part of preoperative assessment. In this case, the patient underwent lobectomy safely following steroid administration. The optimal timing of surgery in patients with preoperative ICI-induced destructive thyroiditis requires further investigation.
免疫检查点抑制剂（ICI）作为局部晚期且可切除的非小细胞肺癌的新辅助治疗方法的应用正在增加。因此，在手术前可能会观察到免疫相关不良事件（irAE），可能需要术前干预。我们报告了一例因新辅助ICI治疗引起的破坏性甲状腺炎患者的病例，该患者在接受类固醇治疗后进行了手术切除。
一名74岁女性在治疗另一种疾病期间被诊断出右上叶生长缓慢的鳞状细胞癌。影像学检查显示右上叶有一个提示肺转移的小结节以及肺门淋巴结转移。患者最初被诊断为右上叶原发性肺癌（cT3N1M0，ⅢA期，TNM分类，第8版），计划每3周进行一次新辅助纳武单抗联合化疗，共三个周期。第一个周期后，患者出现药物性肾损伤。纳武单抗和化疗停药，计划进行手术切除。然而，手术前一天的实验室分析显示游离三碘甲状腺原氨酸和游离甲状腺素升高，促甲状腺激素降低。随后的检查诊断为irAE导致的破坏性甲状腺炎，手术推迟。口服地塞米松1周，一旦甲状腺功能持续改善，便进行了胸腔镜右上叶切除术。患者术后无任何其他并发症顺利康复。
本报告强调了一例继发于irAE的术前破坏性甲状腺炎病例。对于接受术前ICI治疗的患者，建议将包括甲状腺功能检查在内的常规血液检查作为术前评估的一部分。在本病例中，患者在接受类固醇治疗后安全地接受了肺叶切除术。术前ICI诱导的破坏性甲状腺炎患者的最佳手术时机需要进一步研究。
