Work

Atezolizumab-Induced Thyroiditis and Immune Checkpoint Inhibitor (ICI)-Type 1 Diabetes Mellitus: Diagnostic and Therapeutic Challenges in ICI-Associated Endocrinopathies

Year: 2025

Type: article

Abstract: The rapid evolution and increased application of immune checkpoint inhibitors (ICIs) in the oncology setting have introduced novel diagnostic and therapeutic challenges, particularly in the setting of endocrine immune-related adverse events (irAEs). Thyroid dysfunction is among the most common of these, while ICI-type 1 diabetes mellitus is uncommon and can present abruptly with life-threatening complications. A 76-year-old man with extensive-stage small-cell lung cancer being treated with atezolizumab developed new-onset diabetes, which manifested as diabetic ketoacidosis in connection with immunotherapy-induced thyroiditis. Metabolic instability in this patient was compounded by the inappropriate initiation of thyroid hormone replacement during the thyrotoxic phase of the thyroiditis as a result of misinterpretation of his thyroid function tests (TFTs). The unique clinical course of this patient illustrates the broad and unpredictable spectrum of ICI-related endocrinopathies and highlights the importance of prudent interpretation of TFTs, early recognition of ICI-induced type 1 diabetes mellitus, and close multidisciplinary management of irAEs.

Source: Cureus

DOI: 10.7759/cureus.94593

Authors: Rafal Al-Rubaye, Sabha Nadeem, Ahmed Abdulkader Zaki Ali Soliman

Institutions: Shrewsbury and Telford Hospital NHS Trust, Royal Stoke University Hospital

Language: English

Topic: Cancer Immunotherapy and Biomarkers

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4415164236