Nivolumab
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Nivolumab Graves disease and type 1 diabetes : case report
A 48-year-old man developed Graves’ disease and type 1 diabetes during treatment with nivolumab for parotid gland adenocarcinoma. The man, who had parotid gland adenocarcinoma with lung metastasis, received 5 courses of nivolumab 240mg every 2–5 weeks for approximately 13 weeks [route not stated]. During administration of the sixth course (113 days after the first nivolumab), his glycated haemoglobin level was 6.4%, casual plasma glucose was 190 mg/dL, thyroid-stimulating hormone (TSH) level was elevated. Thus, his seventh nivolumab course was discontinued. After 14 days, his glycated haemoglobin and casual plasma glucose levels peaked along with increased free thyroxine and free triiodothyronine levels. TSH level had decreased. Thus, he was immediately hospitalised. His family history of thyroid diseases and other autoimmune diseases was unremarkable. At admission various laboratory examinations were performed. Based on the laboratory findings, he was diagnosed with nivolumab-associated type 1 diabetes. Human leukocyte antigen (HLA) was DRB1*04:05 allele. The man was immediately treated with intensive insulin therapy with improvement in his plasma glucose levels. He was discharged on day 25 of admission. Approximately 9 months post-discharge his seventh and subsequent nivolumab courses were resumed. After the 31st course of nivolumab therapy (835 days after the first nivolumab) CT scan showed disease progression. Meanwhile, his TSH receptor antibody titer had increased 3.7 IU/L, but thyroid peroxidase antibody and thyroglobulin antibody were both negative. Although thyroid ultrasonography revealed no enlargement and normal vascularity of the thyroid gland, he was clinically diagnosed with mild Graves’ disease and started receiving thiamazole [methimazole] therapy. Subsequently, his TSH and free triiodothyronine levels, which decreased soon after starting thiamazole, had again increased at 213 days after manifesting Graves’ disease, despite using thiamazole. Kurihara S, et al. Simultaneous development of Graves’ disease and type 1 diabetes during anti-programmed cell death-1 therapy: A case report. Journal of Diabetes Investigation 11: 1006-1009, No. 4, Jul 2020. Available from: URL: http://doi.org/10.1111/jdi.13212
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Reactions 29 Aug 2020 No. 1819
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