Immune-related thyroid dysfunction induced by toripalimab
10.3760/cma.j.cn114015-20201008-01018
- VernacularTitle:特瑞普利单抗致免疫相关性甲状腺功能异常
- Author:
Chunhui WANG
1
;
Wei WU
;
Xiaoyu LI
;
Qianzhou LYU
;
Bei XU
Author Information
1. 复旦大学附属中山医院药剂科，上海 200032
- Publication Type:Journal Article
- Keywords:
Antineoplastic agents, immunological;
Hyperthyroidism;
Hypothyroidism;
Thyroiditis, autoimmune;
Toripalimab
- From:
Adverse Drug Reactions Journal
2021;23(3):158-160
- CountryChina
- Language:Chinese
-
Abstract:
A 60-year-old male patient with lung cancer received IV infusions of toripalimab 200 mg, bevacizumab 500 mg, and pemetrexed 1 g (the treatment was given on day 1 and 21 days was a cycle) due to the progression of tumor after 26 months of first-line and second-line chemotherapy successively. His thyroid function was normal before treatment. After the second medication of toripalimab (on day 30 after the first medication), the patient developed symptoms such as increased heart rate, fear of heat, hyperhidrosis, and weight loss. The reexamination of thyroid function showed triiodothyronine (T 3) 3.4 nmol/L, thyroxine (T 4) 305.0 nmol/L, free triiodothyronine (FT 3) 13.1 pmol/L, free thyroxine (FT 4) 55.7 pmol/L, thyroid stimulating hormone (TSH) 0.02 mU/L, thyroglobulin (Tg) 32.7 μg/L, antithyroglobulin antibody (TgAb) 531.0 kU/L, antithyroid peroxidase antibody (TPOAb) 318.0 kU/L, and thyroid stimulating hormone receptor antibody (TRAb) 1.00 U/L. Hyperthyroidism was considered, anti-tumor treatment was suspended, and symptoms were improved after metoprolol treatment. Ninety-seven days after the first toripalimab treatment, the patient developed symptoms such as chills, dizziness, fatigue, eyelid edema, weight gain, etc. The laboratory tests showed T 3 0.3 nmol/L, T 4 20 nmol/L, FT 3 1.0 pmol/L, FT 4 1.8 pmol/L, TSH>100.00 mU/L, and carcinoembryonic antigen 251 μg/L. Hypothyroidism was considered, but the tumor progressed, so the treatment of toripalimab was restarted and thyroxine was supplemented at the same time. The patient′s thyroid function was gradually improved and then remained normal. More than 13 months after the first medication of toripalimab, the laboratory tests showed T 3 1.3 nmol/L, T 4 137.0 nmol/L, FT 3 3.8 pmol/L, FT 4 21.1 pmol/L, TSH 6.03 mU/L, Tg 3.9 μg/L, TgAb 432.0 kU/L, and TPOAb 222.0 kU/L.
