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Peer-reviewedCC BY 4.0Frontiers in Oncology

Pembrolizumab-associated primary hypothyroidism followed by central hypothyroidism: a case report

  • Jiawei Sun1
  • Chunnuo Wang2
  • Zhanzhan Sun3
  • Wei Li4
4 affiliations
  1. 1Department of Nephrology, Cixi People’s Hospital, Wenzhou Medical University
  2. 2Department of Medical Imaging (Radiology), Cixi People’s Hospital, Wenzhou Medical University
  3. 3Department of Endocrinology, Cixi People Hospital Medical Health Group (Cixi People Hospital)
  4. 4Department of Endocrinology, Ningbo Medical Center Lihuili Hospital
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Abstract

Introduction: PD-1 inhibitors are widely used anticancer drugs and frequently trigger immune-related adverse events, with thyroid dysfunction as the most prevalent. Suspected isolated central hypothyroidism emerging during PD-1 inhibitor therapy has rarely been documented.

Case presentation: A 56-year-old man received pembrolizumab for esophageal squamous cell carcinoma. Before treatment, he had pre-existing Hashimoto’s thyroiditis with low TT4 and normal TSH. He developed painless thyroiditis manifesting as transient thyrotoxicosis followed by primary hypothyroidism. Shortly after hypothyroidism was pharmacologically controlled, TSH progressively declined to the lower limit of detection, accompanied by low TT4. Pituitary MRI showed pituitary gland thinning without focal structural abnormalities. Integrating the clinical course, central hypothyroidism was considered. Given altered upper gastrointestinal anatomy after esophagectomy, split-dose levothyroxine was administered, and the patient’s FT4 levels remained stable.

Conclusion: This rare sequential evolution of thyroid dysfunction may represent an uncommon endocrine immune-related adverse event of immune checkpoint inhibitors.

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Cite

BibTeXRIS
BibTeX
@article{sun2026pembrolizumabassociated,
  title = {{Pembrolizumab-associated primary hypothyroidism followed by central hypothyroidism: a case report}},
  author = {Jiawei Sun and Chunnuo Wang and Zhanzhan Sun and Wei Li},
  journal = {Frontiers in Oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1978296},
  url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1978296/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Pembrolizumab-associated primary hypothyroidism followed by central hypothyroidism: a case report
AU  - Jiawei Sun
AU  - Chunnuo Wang
AU  - Zhanzhan Sun
AU  - Wei Li
PY  - 2026
DA  - 2026/10/15
JO  - Frontiers in Oncology
DO  - 10.3389/fonc.2026.1978296
UR  - https://www.frontiersin.org/articles/10.3389/fonc.2026.1978296/full
AB  - Introduction: PD-1 inhibitors are widely used anticancer drugs and frequently trigger immune-related adverse events, with thyroid dysfunction as the most prevalent. Suspected isolated central hypothyroidism emerging during PD-1 inhibitor therapy has rarely been documented.  Case presentation: A 56-year-old man received pembrolizumab for esophageal squamous cell carcinoma. Before treatment, he had pre-existing Hashimoto’s thyroiditis with low TT4 and normal TSH. He developed painless thyroiditis manifesting as transient thyrotoxicosis followed by primary hypothyroidism. Shortly after hypothyroidism was pharmacologically controlled, TSH progressively declined to the lower limit of detection, accompanied by low TT4. Pituitary MRI showed pituitary gland thinning without focal structural abnormalities. Integrating the clinical course, central hypothyroidism was considered. Given altered upper gastrointestinal anatomy after esophagectomy, split-dose levothyroxine was administered, and the patient’s FT4 levels remained stable.  Conclusion: This rare sequential evolution of thyroid dysfunction may represent an uncommon endocrine immune-related adverse event of immune checkpoint inhibitors.
SN  - 2234-943X
ER  -