Nivolumab致甲状腺功能减退症1例

Nivolumab-induced hypothyroidism: A case report

Nivolumab是一种抗PD-1单克隆抗体,用于肿瘤免疫治疗。中南大学湘雅三医院内分泌科收治1例肠癌术后3年的73岁女性患者,用nivolumab治疗后引起严重甲状腺功能减退症。患者接受nivolumab治疗4个月后出现乏力、头晕、皮肤变黄及眼睑浮肿等症状,FT3和FT4减低,TSH升高,随后终止nivolumab治疗,用左甲状腺素钠片替代治疗后患者症状缓解,甲状腺功能恢复正常。临床诊断为nivolumab诱导自身免疫甲状腺损害,为治疗中免疫相关不良反应。

Nivolumab is an anti-programmed cell death (anti-PD-1) monoclonal antibody, which is a new drug for tumor immunotherapy. A 73-year-old female patient with colorectal cancer 3 years aft er surgery was treated in the Endocrinology Department of Th ird Xiangya Hospital, Central South University, who developed severe hypothyroidism resulting from treatment with nivolumab. Aft er 4 months treatment of nivolumab, this patient presented with symptoms such as fatigue, dizziness, jaundice and palpebral edema, with decreased levels of FT3 and FT4 and elevated levels of TSH. Subsequently, nivolumab treatment was terminated. This patient’s symptoms were relieved and thyroid function returned to normal aft er thyroxine replacement therapy. Th e clinical diagnosis was considered to be nivolumab-induced autoimmune thyroid damage, which was an immune-related adverse reaction in the treatment.