Abstract
BackgroundRecently, 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.Case presentationAn 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 99mTc-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.ConclusionIt might be important to be aware of the possibility of thyroid storm induced by immune checkpoint inhibitors.
Highlights
Immune checkpoint inhibitors have widely been used for the management of advanced melanoma
We present a very rare case of thyroid storm in a patient with advanced melanoma receiving dual ipilimumab and nivolumab therapy and discuss the clinical presentation and therapeutic interventions in a patient with Hashimoto’s disease and type 2 diabetes mellitus
Case presentation An 85-year-old Japanese man with a history of malignant melanoma of the nasal cavity presented to our department with severe thyrotoxicosis and poor blood glucose control
Summary
Thyroid storm is an acute, life-threatening state induced by excessive release of thyroid hormones in individuals with thyrotoxicosis. We present a very rare case of thyroid storm in a patient with advanced melanoma receiving dual ipilimumab and nivolumab therapy and discuss the clinical presentation and therapeutic interventions in a patient with Hashimoto’s disease and type 2 diabetes mellitus. Case presentation An 85-year-old Japanese man with a history of malignant melanoma of the nasal cavity presented to our department with severe thyrotoxicosis and poor blood glucose control He had been treated for hypothyroidism secondary to Hashimoto’s disease and type 2 diabetes mellitus with insulin self-injection therapy before undergoing treatment of malignant melanoma. He was diaphoretic with jugular venous distension and peripheral edema, and his chest was clinically clear His medical history included hypothyroidism due to Hashimoto’s disease, diagnosed at 62 years of age and treated with thyroid hormone replacement, as well as type 2 diabetes mellitus treated by self-injection of insulin with a good glycemic control. He was discharged from our hospital on day 35 on daily maintenance insulin injection and levothyroxine sodium hydrate
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