So Slow, so Fast, a Case of Nivolumab-Induced Hypothyroidism with Subsequent Rhabdomyolysis

Abstract

Background: Immunotherapy has revolutionized the treatment of cancer, but this has not come without a cost. Although immune checkpoint inhibitors are less toxic than conventional chemotherapy, they are associated with more frequent autoimmune side effects. Case presentation: We report a case of a patient with metastatic renal cell carcinoma who was treated with nivolumab and subsequently developed treatment related hypothyroidism with consequent rhabdomyolysis. Treatment with thyroxine resulted in resolution of the symptoms. Because of normal thyroid function tests before initiating nivolumab therapy and the absence of any other causes of hypothyroidism, it was safe to extrapolate a causal relationship between nivolumab and hypothyroidism. To date, this is the first reported case of a programmed cell death-1 inhibitor causing hypothyroidism, severe enough to induce rhabdomyolysis. Conclusion: Patients on nivolumab and other PD-1 inhibitors should be monitored and screened regularly for immune-related adverse events.

Life-Threatening Endocrinological Immune-Related Adverse Events of Immune Checkpoint Inhibitor Therapy

“…Some reports in the literature also describe myopathy and rhabdomyolysis during hypothyroidism after ICI treatment [88][89][90][91].…”

Acetylcholine receptor binding antibody–associated myasthenia gravis, myocarditis, and rhabdomyolysis induced by tislelizumab in a patient with colon cancer: A case report and literature review

“…PD-1 inhibitors facilitate restore the endogenous anti-tumor T cell response by blocking the binding of PD-1 to PD-L1 and PD-L2. PD-1 inhibitors, such as nivolumab, have been approved by the US Food and Drug Administration (FDA) for a wide range of cancers, such as melanoma, renal cell carcinoma (RCC), colon cancer, bladder cancer, and Hodgkin’s lymphoma since 2014 ( 2 ). Despite the impressive efficacy, ICI-related toxicities (i.e., immune-related adverse events and irAEs) should not be neglected, as many irAEs such as myocarditis and rhabdomyolysis are covert and fatal ( 3 , 4 ).…”