{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:21:28Z","timestamp":1782476488393,"version":"3.54.5"},"reference-count":24,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,30]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>While immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, they can cause immune-related adverse events, including thyroid dysfunction and rarely, thyroid storm. Here, we present a rare case of thyroid storm occurring during ICI therapy, in which clinical and immunological findings strongly suggested Graves\u2019 disease. A man in his 80s with advanced lung cancer was hospitalised for multiple rib fractures. During admission, he developed fever, delirium, atrial fibrillation and marked thyrotoxicosis, leading to a diagnosis of thyroid storm. Given his prior treatment with nivolumab and ipilimumab, destructive thyroiditis was initially suspected, as this is the most common mechanism of ICI-associated thyrotoxicosis. However, marked thyroid-stimulating antibody positivity was more suggestive of Graves\u2019 disease than destructive thyroiditis. This case highlights that ICI therapy-associated thyroid storm can arise not only from destructive thyroiditis but also from Graves\u2019 disease. Therefore, careful clinical evaluation is essential to determine the underlying pathophysiology and guide optimal management.<\/jats:p>","DOI":"10.1136\/bcr-2026-272027","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:10:34Z","timestamp":1780319434000},"page":"e272027","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Thyroid storm triggered by immune checkpoint inhibitor therapy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6552-9023","authenticated-orcid":false,"given":"Junya","family":"Hagiwara","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Sapporo Medical University Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miku","family":"Sekine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Sakawaki","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hakodate Municipal Hospital, Hakodate, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonoko","family":"Sakawaki","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hakodate Municipal Hospital, Hakodate, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Takeyama","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hakodate Municipal Hospital, Hakodate, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"2026060106101482000_19.6.e272027.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1712126"},{"key":"2026060106101482000_19.6.e272027.2","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2023.1192762","article-title":"Immune checkpoint inhibitors efficacy across solid cancers and the utility of PD-L1 as a biomarker of response: a systematic review and meta-analysis","volume":"10","author":"Fitzsimmons","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"2026060106101482000_19.6.e272027.3","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-019-0218-0"},{"key":"2026060106101482000_19.6.e272027.4","doi-asserted-by":"publisher","DOI":"10.1158\/2326-6066.CIR-17-0208"},{"key":"2026060106101482000_19.6.e272027.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1901214"},{"key":"2026060106101482000_19.6.e272027.6","doi-asserted-by":"publisher","DOI":"10.1038\/nrc3236"},{"key":"2026060106101482000_19.6.e272027.7","doi-asserted-by":"crossref","DOI":"10.1186\/s40425-019-0754-2","article-title":"Endocrine toxicity of immune checkpoint inhibitors: a real-world study leveraging US Food and Drug Administration adverse events reporting system","volume":"7","author":"Zhai","year":"2019","journal-title":"J Immunother Cancer"},{"key":"2026060106101482000_19.6.e272027.8","article-title":"A novel melanoma therapy stirs up a storm: ipilimumab-induced thyrotoxicosis","volume":"2015","author":"Yu","year":"2015","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"2026060106101482000_19.6.e272027.9","doi-asserted-by":"crossref","unstructured":"McMillen B , Dhillon MS , Yong-Yow S . A rare case of thyroid storm. BMJ Case Rep 2016. doi:10.1136\/bcr-2016-214603","DOI":"10.1136\/bcr-2016-214603"},{"key":"2026060106101482000_19.6.e272027.10","doi-asserted-by":"crossref","DOI":"10.1186\/s13256-018-1708-x","article-title":"Combination therapy of ipilimumab and nivolumab induced thyroid storm in a patient with Hashimoto\u2019s disease and diabetes mellitus: a case report","volume":"12","author":"Yonezaki","year":"2018","journal-title":"J Med Case Rep"},{"key":"2026060106101482000_19.6.e272027.11","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-250696","article-title":"Thyroid storm induced by combined nivolumab and ipilimumab immunotherapy in advanced non-small cell lung cancer","volume":"15","author":"Kataoka","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2026060106101482000_19.6.e272027.12","article-title":"Thyroid Storm and Type 1 Diabetes Mellitus Induced by Combined Ipilimumab and Nivolumab Immunotherapy: A Case Report","volume":"15","author":"Ramburuth","year":"2023","journal-title":"Cureus"},{"key":"2026060106101482000_19.6.e272027.13","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1080\/08998280.2024.2413320","article-title":"Pembrolizumab-induced thyroid storm","volume":"38","author":"Niedzialkowska","year":"2025","journal-title":"Baylor University Medical Center Proceedings"},{"key":"2026060106101482000_19.6.e272027.14","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.aed.2025.04.008","article-title":"Pembrolizumab-Induced Thyroid Storm in a Patient With Triple-Negative Breast Cancer","volume":"12","author":"Mohammed","year":"2025","journal-title":"AACE Endocrinol Diabetes"},{"key":"2026060106101482000_19.6.e272027.15","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0889-8529(18)30165-8","article-title":"Life-threatening thyrotoxicosis. 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Graves\u2019 Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review). 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