Journal List > Int J Thyroidol > v.11(2) > 1109116

Kim, Kim, Song, and Cho: A Case of Aggravation of Thyroid Goiter after Treatment with PD-1 Inhibitor for Breast Cancer in Patients with Underlying Hashimoto's Thyroiditis

초록

Anti-programmed cell death-1 (PD-1) humanized monoclonal antibody inhibits PD-1 activity by binding to the PD-1 receptor on T-cells and blocking PD-1 ligands and induces immune tolerance of cancer cells. It has been widely used for various kinds of cancer treatment. However, many immune-related adverse events (irAEs) have been reported because it modulates our immune system. In this case study, we reported a case of 42-year-old woman with Hashimoto's thyroiditis who showed rapid aggravation of thyroid goiter and acute hyperventilation syndrome after treatment with PD-1 inhibitor as a neoadjuvant chemotherapy for breast cancer.

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Fig. 1.
Representative images of thyroid ultrasonography. (A) Diffuse enlargement of goiter and increased blood flow in left thyroid gland at the time of respiratory distress. (B) The size of right middle lobe was 25.9×28.2×45.7 mm at the time of respiratory distress. (C) Twenty days after treatment with prednisolone, the size of right thyroid middle lobe was 22.9×15.0×43.8 mm and the volume decreased by 54%.
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Table 1.
The changes in thyroid function and thyroid autoantibodies with treatment of steroid and levothyroxine
Reference range Before PD-1 inhibitor Weeks after PD-1 inhibitor
4 8 10 12 15 23
TSH (μ IU/mL) 0.35-4.94 0.3 <0.01 4.93 29.44 35.61 37.8 8.91
Free T4 (ng/dL) 0.70-1.48 1.23 2.16 0.56 0.4 0.75 0.68 0.88
Total T3 (ng/dL) 58-159 85.5 178.4 52.3 <25.0 51.7 53.3 77.2
Anti-TPO Ab (U/mL) 0-60   1884       1277 658
Anti-Tg Ab (U/mL) 0-60           114 87
Prednisolone (mg/day)       10 5 Stop    
Levothyroxine (μ g/day)         50 50 75 100
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