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Thyroid dysfunction in patients undergoing Nivolumab cancer treatment: Case reports and review of literature
1 Postgraduate Program in Clinical and Experimental Pathophysiology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
2 Internal Medicine Division, Hospital Universitário Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
3 Corporate Affairs Executive Manager, Oncoclínicas Group, São Paulo, Brazil
4 Diagnósticos da América SA, Rio de Janeiro, Brazil
5 Endocrine Division, Hospital Universitário Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
Address correspondence to:
Bárbara Gehrke
Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro 20551-030,
Brazil
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Article ID: 101223Z01BG2021
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Gehrke B, Oliveira RA, Canedo JAF, Araujo PB, Coelho MCA. Thyroid dysfunction in patients undergoing Nivolumab cancer treatment: Case reports and review of literature. Int J Case Rep Images 2021;12:101223Z01BG2021.ABSTRACT
Introduction: The recent development of anticancer treatments focused on disrupting the signaling pathways has arrived as a promising alternative for conditions previously untreatable. Nivolumab is a second-generation monoclonal antibody that works as a negative regulatory agonist of the programmed cell death protein 1 (PD-1) receptor expressed by B and T lymphocytes and natural killer cells, preventing the binding of PD-1 to its ligands programmed cell death ligand-1 (PD-L1) and programmed cell death ligand-2 (PD-L2), therefore protecting healthy tissues. As a result of an increased immune system activity, this may provide inflammatory side effects known as immune-related adverse events (IRAEs). Thyroid dysfunction (TD) is frequently observed in patients using Anti-PD-1.
Case Report: Our case report refers to two patients of 67 and 75 years old, feminine and masculine genders, respectively, that developed Nivolumab-induced TD with transient hyperthyroidism and posterior evolution to hypothyroidism. Both were treated with Levothyroxine after thyrotoxicosis phase.
Conclusion: Thyroid dysfunction has been a recurrent IRAE described in patients using Anti-PD-1 and it is usually a treatable condition. Our patients manifested a less common TD known as lymphocytic thyroiditis. Because there is an increased tendency of using immune checkpoint inhibitors, both cases highlight the importance of close monitoring to detect the development and progression of TD, avoiding preventable morbidity and allowing to maintain cancer therapy.
Keywords: Immune checkpoint inhibitors, Neoplasms, Nivolumab, Thyroiditis
SUPPORTING INFORMATION
Author Contributions
Bárbara Gehrke - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ricardo de Andrade Oliveira - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Jorge Alexandre Fernandes Canedo - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Paula Bruna Araujo - Conception of the work, Design of the work, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Maria Caroline Alves Coelho - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Bárbara Gehrke et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
