Mohammed Sobrina S, Park Eun Young, Asad Reda, Tadisina Shourya
Division of Endocrinology, Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
Department of Medicine and Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
AACE Endocrinol Diabetes. 2025 May 2;12(2):107-111. doi: 10.1016/j.aed.2025.04.008. eCollection 2025 Jul-Aug.
BACKGROUND/OBJECTIVE: Thyroid immune-related adverse events (irAEs) are a common occurrence with the use of anti-programmed cell death-1 agents such as pembrolizumab. Anti-programmed cell death-1-induced thyroid storm in the absence of autoimmune thyroid disease is a rare but potentially fatal complication. This report aims to highlight the varied spectrum of thyroid irAEs, emphasize the importance of early detection, and discuss the challenges involved in diagnosing and managing these conditions.
A 50-year-old African American woman with type 2 diabetes mellitus, hypertension, and stage IIIc triple-negative breast cancer receiving neoadjuvant chemotherapy and pembrolizumab presented with severe thyrotoxicosis. Her Burch-Wartofsky score was >45, indicating thyroid storm. Thyroid antibodies were negative. She was treated with propylthiouracil, hydrocortisone, and beta-blockers, later transitioning to methimazole. She progressed to hypothyroidism and requiring long-term levothyroxine replacement. Eight months later, her thyroid function normalized, and she continued her cancer treatment with pembrolizumab, remaining asymptomatic and under regular follow-up.
Awareness of the spectrum of thyroid irAEs is crucial because they can range from subclinical disease to more severe manifestations such as thyroid storm, even in the absence of autoimmune thyroid disease. Early detection and management of these conditions can significantly improve patient outcomes and ensure the safe continuation of immunotherapy treatments.
Pembrolizumab precipitated thyroiditis culminating in thyroid storm, as evidenced by the temporal relationship with therapy and development of severe thyrotoxicosis followed by hypothyroidism and the lack of thyroid autoantibodies. Clinicians should remain vigilant regarding the potential for thyroid storm in patients undergoing pembrolizumab treatment.
背景/目的：甲状腺免疫相关不良事件（irAEs）是使用派姆单抗等抗程序性细胞死亡-1药物时的常见现象。在无自身免疫性甲状腺疾病的情况下，抗程序性细胞死亡-1诱导的甲状腺风暴是一种罕见但可能致命的并发症。本报告旨在突出甲状腺irAEs的多种表现形式，强调早期检测的重要性，并讨论诊断和管理这些病症所涉及的挑战。
一名50岁的非裔美国女性，患有2型糖尿病、高血压和IIIc期三阴性乳腺癌，正在接受新辅助化疗和派姆单抗治疗，出现了严重的甲状腺毒症。她的伯奇-沃托夫斯基评分>45，表明发生了甲状腺风暴。甲状腺抗体为阴性。她接受了丙硫氧嘧啶、氢化可的松和β受体阻滞剂治疗，后来改用甲巯咪唑。她进展为甲状腺功能减退，需要长期服用左甲状腺素替代治疗。八个月后，她的甲状腺功能恢复正常，继续使用派姆单抗进行癌症治疗，仍无症状并接受定期随访。
了解甲状腺irAEs的表现范围至关重要，因为即使在无自身免疫性甲状腺疾病的情况下，它们也可能从亚临床疾病到更严重的表现形式，如甲状腺风暴。早期检测和管理这些病症可显著改善患者预后，并确保免疫治疗的安全持续进行。
派姆单抗引发了甲状腺炎，最终导致甲状腺风暴，这从与治疗时间关系、严重甲状腺毒症随后出现甲状腺功能减退以及缺乏甲状腺自身抗体得到证明。临床医生应对接受派姆单抗治疗的患者发生甲状腺风暴的可能性保持警惕。
