Diabetes ketoacidosis and hypothyroidism caused by tislelizumab
10.3760/cma.j.cn114015-20241118-00153
- VernacularTitle:替雷利珠单抗致糖尿病酮症酸中毒和甲状腺功能减退
- Author:
Zhongyan ZHOU
1
;
Kexin WANG
1
;
Yanfang WANG
1
;
Erxia SHI
1
Author Information
1. 呼和浩特市第一医院药剂科，呼和浩特 010030
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Diabetic ketoacidosis;
Hypothyroidism;
Tislelizumab;
Immune-related advert events
- From:
Adverse Drug Reactions Journal
2025;27(10):629-631
- CountryChina
- Language:Chinese
-
Abstract:
A 70-year-old male patient with T2N2M0 stage Ⅲ A lung squamous cell carcinoma was switched to monotherapy with tislelizumab (200 mg by intravenous infusion on day 1, 21 days as a cycle) after 5 cycles of chemotherapy with paclitaxel protein-bound and cisplatin, one cycle of combined chemotherapy and immunotherapy with tislelizumab, paclitaxel protein-bound and cisplatin. After 10 days of tislelizumab administration in the 4th cycle of monotherapy, the patient developed symptoms such as nausea, vomiting, abdominal pain, and abdominal distension. Laboratory tests showed fasting blood glucose of 26.3 mmol/L, glycated hemoglobin of 12.5%, fasting C-peptide<0.01 μg/L, free triiodothyronine of 3.31 pmol/L, free thyroxine of 4.9 pmol/L, and thyroid stimulating hormone of 49.4 mU/L, urinary ketones (++), and urinary glucose (++). Ketoacidosis and hypothyroidism were diagnosed, which was considered to be caused by tislelizumab. After 7 days of treatments with insulin, fluid replacement, potassium supplementation, and maintenance of electrolytes and acid-base balance, the patient′s fasting blood glucose was 7.6 mmol/L. The hypoglycemic regimen was changed to subcutaneous injection insulin glargine (10 U in the morning) and insulin lispro (6 U before breakfast, 5 U before lunch and dinner), and levothyroxine sodium 100 μg once daily orally was given at the same time. Two weeks later, due to the condition, the patient received tislelizumab again once, and subsequently developed ketoacidosis 3 times. Tislelizumab was not used again thereafter. Follow-up once a month within 6 months showed no significant changes in the patient′s thyroid function compared to before. The patient continued to use insulin to control blood glucose.
