Thyroid-Like Ophthalmopathy in a Euthyroid Patient Receiving Ipilimumab

Abstract

A 68-year-old lady with metastatic malignant melanoma was treated with Ipilimumab. She presented to Eye Casualty unable to move her eyes. Physical examination confirmed ophthalmoplegia and identified proptosis bilaterally. Radiological imaging showed bilateral enlargement of all the extra-ocular muscles suggestive of thyroid eye disease. Laboratory investigations found this patient to be euthyroid. A diagnosis of thyroid-like orbitopathy secondary to Ipilimumab therapy was made. Thyroid function tests should be performed for all patients prior to their commencement of Ipilimumab. Thyroid-like eye disease may develop in patients treated with Ipilimumab even if they remain euthyroid.

Tremelimumab-Induced Graves Hyperthyroidism

“…From clinical experience, thyroid dysfunction is commonly reported following anti-CTLA-4 therapy [7]. Ipilimumab has been shown to induce hypothyroidism/thyroiditis [23], euthyroid Graves ophthalmopathy [24], and Graves thyrotoxicosis [25]. In a single centre specialising in immune modulatory therapy, 6% of the 256 patients were found to have hypothyroidism/thyroiditis following ipilimumab therapy, with a male to female ratio of 2: 3 [26].…”

Endocrine side effects of cancer immunotherapy

“…The spectrum of thyroid disturbances associated with immune checkpoint inhibitors include painless thyroiditis with transient thyrotoxicosis, transient or long-standing hypothyroidism, thyroid eye disease and occasionally severe forms of thyroid disease such as thyroid storm (Borodic et al 2011, Hamnvik et al 2011, Min et al 2011, McElnea et al 2014, Min & Hodi 2014, Carl et al 2015, Orlov et al 2015, Yu et al 2015, Joshi et al 2016. Rare cases of Graves' ophtalmopathy have been reported with elevation of TSH-receptor antibodies but normal thyroid function (Borodic et al 2011, Min et al 2011.…”

Thyroid-Induced Toxicity of Check-Point Inhibitors Immunotherapy in the Treatment of Advanced Non-Small Cell Lung Cancer

“…A case of thyroidlike orbitopathy was described during ipilimumab therapy in a woman with normal levels of thyroid hormones, euthyroid, but with an ophthalmopathy similar to that seen in Graves' disease, sustained by TSAbs [53].…”