Case of Induced Grave’s Disease by Nivolumab Treatment

Immune checkpoint inhibitors (ICIs) are powerful new drugs for the treatment of cancer. Immune-related adverse events (irAEs), despite their successful use in oncology, resulted in a wide range of adverse effects. Transient thyrotoxicosis and hypothyroidism cause the majority of immune-related thyroid dysfunctions, but there are also reported a few cases of ICI-induced hyperthyroidism. We present a case of Graves' disease resulted from anti-PD-1 therapy. A 63-year-old male developed tachycardia, palpitations, excessive perspiration, and vivid, horrific dreams after the sixth infusion of Nivolumab for metastatic melanoma. His thyroid function test (TFT) was abnormal, and he was treated with methimazole and propranolol. Ten weeks after starting methimazole, the TFT returned to normal, and the symptoms subsided. In a nutshell, even though Grave's disease is a rare complication of immunotherapy, it is very important always keep it in mind to ensure quick access to prompt diagnosis and treatment to maintain a good quality of life and overall survival.