Hypothyroidism as an immune-related adverse event caused by atezolizumab in a patient with muscle spasms: a case report

• Published in: Respiratory medicine case reports Vol. 36; p. 101585
• Main Authors: Kawataki, Masanori, Nakanishi, Yosuke, Yokoyama, Toshihide, Ishida, Tadashi
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2022; Elsevier
• Subjects: Case Report; hyperCKemia; Hyperthyroidism; Hypothyroidism; Immune checkpoint inhibitors (ICIs); Immune-related adverse events (irAEs); Muscle cramps; Immune-related adverse events (irAEs); Immune checkpoint inhibitors (ICIs); hyperCKemia; Hyperthyroidism; ICIs; TSH; Hypothyroidism; TPO Ab; Muscle cramps; TRAb; nab-PTX; irAEs; CPK; TRAb, Antithyrotropin receptor antibody; TSH, thyroid stimulating hormone; ICIs, immune checkpoint inhibitors; nab-PTX, nab-paclitaxel; CPK, creatine phosphokinase; irAEs, immune-related adverse events; TPO Ab, Antithyroperoxidase antibody
• ISSN: 2213-0071; 2213-0071
• DOI: 10.1016/j.rmcr.2022.101585

A 60-year-old man with a history of 4 cycles of atezolizumab treatment for non-small cell lung cancer presented to our hospital with a chief complaint of proximal muscle-dominant spasms. Blood tests showed elevated creatine phosphokinase (CPK) of 8450 U/L and hypothyroidism. There was little improvement even after stopping levetiracetam and pregabalin, and no suspicious physical findings of myositis. After levothyroxine was started for hypothyroidism, his muscle cramps and serum CPK level improved. Hypothyroidism as an immune-related adverse event can cause muscle spasms and is important in the differential diagnosis of muscle spasms in patients treated with immune checkpoint inhibitors.