Treatment of Ipilimumab Induced Graves’ Disease in a Patient with Metastatic Melanoma
Open accessAbstract
Objective. Thyroid disease has been reported among the endocrinopathies that can occur after treatment with ipilimumab. Graves’ disease, however, has been rarely reported with this medication. Here we report a case of Graves’ disease diagnosed after initiation of ipilimumab in a patient with melanoma.Methods. We present the clinical presentation and management course of this patient followed by a related literature review.Results. A 67-year-old male with metastatic melanoma was started on ipilimumab. He developed hyperthyroidism after two doses of ipilimumab. The cause of hyperthyroidism was determined to be Graves’ disease. Ipilimumab was held and the patient was started on methimazole with return to euthyroid status. Ipilimumab was resumed and the patient continued methimazole during the course of ipilimumab therapy, with controlled hyperthyroidism. Restaging studies following four cycles of ipilimumab showed complete response in the lungs, with residual melanoma in the neck. The patient then underwent total thyroidectomy and left neck dissection as a definitive treatment for both hyperthyroidism and residual melanoma.Conclusion. Graves’ disease can develop after starting ipilimumab and methimazole can be an effective treatment. For patients whose hyperthyroidism is well-controlled on methimazole, ipilimumab may be resumed with close monitoring.
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In the literature, only nine cases of ICPi-induced Graves' hyperthyroidism and seven cases of induced Graves' orbitopathy have been described, associated with anti-PD-1 or anti-CTLA-4 treatment or their combination, with only one patient presenting both thyrotoxicosis and orbitopathy.
“To the best of our knowledge at the time of writing, only nine cases of ICPi-induced Graves’ hyperthyroidism and seven cases of induced Graves’ orbitopathy have been described in the literature, associated with anti-PD-1 or anti-CTLA-4 treatment or their combination (Table 3), with only one patient presenting with both thyrotoxicosis and orbitopathy [19,29,30,31,35,36,37,38,39,40,41,42,43,44].”
From Graves’ Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review) (2021) · cites this paper as [35]
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Graves’ Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review)
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“Azmat, 2016 [35] anti-CTLA-4 (Ipilimumab) 3 mg/kg/2 weeks M 67 No/na Yes No II/6 weeks 2.”
Nivolumab Induced Thyroid Dysfunction: Unusual Clinical Presentation and Challenging Diagnosis
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- Authors
- Azmat, U., Liebner, D., Joehlin-Price, A., Agrawal, A., & Nabhan, F.
- Affiliations
- The Ohio State University (US)
- Corresponding author
- Nabhan, Fadi
- Venue
- Case Reports in Endocrinology
- Publisher
- Wiley
- Published
- 2016
- Volume
- 2016
- Pages
- 1-4
- ISSN
- 2090-6501 (ISSN-L)
- 2090-651X
- PMC
- PMC4737013
- OpenAlex
- W2237934598
- Cited by
- 59
- References
- 4
- Citations by year
- 2025: 2 · 2024: 8 · 2023: 2 · 2022: 6 · 2021: 13 · 2020: 4 · 2019: 10 · 2018: 6 · 2017: 7 · 2016: 1
- FWCI
- 8.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Case Reports in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Keywords
- ipilimumab, Graves' disease, hyperthyroidism, metastatic melanoma, immune checkpoint inhibitors, drug-induced thyroid dysfunction, methimazole, total thyroidectomy, neck dissection, immune-related adverse events
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