Thyroid storm triggered by immune checkpoint inhibitor therapy

Area of Science:

• Oncology
• Endocrinology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) have transformed cancer therapy.
• ICIs can induce immune-related adverse events, including thyroid dysfunction.
• Thyroid storm is a rare but critical complication of ICI therapy.

Purpose of the Study:

• To report a rare case of thyroid storm during ICI therapy.
• To investigate the underlying cause of ICI-associated thyroid storm.
• To emphasize the importance of accurate diagnosis for optimal management.

Main Methods:

• Case report of an elderly male patient with advanced lung cancer.
• Patient received nivolumab and ipilimumab.
• Clinical presentation and immunological markers (thyroid-stimulating antibodies) were analyzed.

Main Results:

• The patient developed thyroid storm characterized by fever, delirium, atrial fibrillation, and thyrotoxicosis.
• Initial suspicion was destructive thyroiditis, a common ICI-related mechanism.
• High thyroid-stimulating antibody levels indicated Graves' disease as the cause.

Conclusions:

• ICI therapy-associated thyroid storm can be caused by Graves' disease, not solely destructive thyroiditis.
• Distinguishing between these mechanisms is crucial for effective patient management.
• Thorough clinical and immunological evaluation is essential in suspected ICI-induced thyroid dysfunction.