{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T17:07:14Z","timestamp":1772816834857,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T00:00:00Z","timestamp":1709942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T00:00:00Z","timestamp":1709942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"CAMS","award":["CAMS Innovation Fund for Medical Sciences\uff08CIFMS\uff09"],"award-info":[{"award-number":["CAMS Innovation Fund for Medical Sciences\uff08CIFMS\uff09"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>With the increasing use of immune checkpoint inhibitors (ICIs) in cancer therapy, perioperative healthcare professionals need to be vigilant about potential immune-related adverse events (irAEs). We report a case of severe postinduction hypotension in a patient undergoing laparotomy due to suspected intraabdominal bleeding from gastric cancer and Krukenberg tumors, caused by unrecognized hypothyroidism precipitated by ICIs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 65-year-old Chinese female with a history of gastric adenocarcinoma and Krukenberg tumors, previously treated with nivolumab, presented to the emergency room with abdominal pain and hypotension. Despite ruling out other causes, including hypovolemia and anaphylaxis, her hypotension persisted. The patient was found to have severe hypothyroidism, likely an irAE from the use of nivolumab. Thyroxine replacement therapy resolved the hypotension, and the patient recovered uneventfully after surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This case underscores the importance of considering irAEs, such as hypothyroidism, in patients treated with ICIs. Perioperative healthcare providers must remain vigilant for potential complications and promptly recognize and manage irAEs to optimize patient outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-024-04375-9","type":"journal-article","created":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T01:06:56Z","timestamp":1709946416000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Profound postinduction hypotension precipitated by immune checkpoint inhibitors: a case report"],"prefix":"10.1186","volume":"18","author":[{"given":"Lu","family":"Che","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunhua","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,3,9]]},"reference":[{"issue":"7","key":"4375_CR1","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1038\/s41574-021-00484-3","volume":"17","author":"JJ Wright","year":"2021","unstructured":"Wright JJ, Powers AC, Johnson DB. Endocrine toxicities of immune checkpoint inhibitors. Nat Rev Endocrinol. 2021;17(7):389\u201399. https:\/\/doi.org\/10.1038\/s41574-021-00484-3.","journal-title":"Nat Rev Endocrinol"},{"issue":"10","key":"4375_CR2","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1089\/thy.2018.0116","volume":"28","author":"PC Iyer","year":"2018","unstructured":"Iyer PC, Cabanillas ME, Waguespack SG, Hu MI, Thosani S, Lavis VR, et al. Immune-related thyroiditis with immune checkpoint inhibitors. Thyroid. 2018;28(10):1243\u201351. https:\/\/doi.org\/10.1089\/thy.2018.0116.","journal-title":"Thyroid"},{"issue":"10","key":"4375_CR3","doi-asserted-by":"publisher","first-page":"2377","DOI":"10.1093\/annonc\/mdx286","volume":"28","author":"L Khoja","year":"2017","unstructured":"Khoja L, Day D, Wei-Wu Chen T, Siu LL, Hansen AR. Tumour- and class-specific patterns of immune-related adverse events of immune checkpoint inhibitors: a systematic review. Ann Oncol. 2017;28(10):2377\u201385. https:\/\/doi.org\/10.1093\/annonc\/mdx286.","journal-title":"Ann Oncol"},{"issue":"4","key":"4375_CR4","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1213\/00000539-198204000-00012","volume":"61","author":"JM Murkin","year":"1982","unstructured":"Murkin JM. Anesthesia and hypothyroidism: a review of thyroxine physiology, pharmacology, and anesthetic implications. Anesth Analg. 1982;61(4):371\u201383.","journal-title":"Anesth Analg"},{"issue":"2","key":"4375_CR5","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/0002-9343(84)90701-0","volume":"77","author":"PW Ladenson","year":"1984","unstructured":"Ladenson PW, Levin AA, Ridgway EC, Daniels GH. Complications of surgery in hypothyroid patients. 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Curr Oncol Rep. 2020;22(4):39. https:\/\/doi.org\/10.1007\/s11912-020-0897-9.","journal-title":"Curr Oncol Rep"},{"key":"4375_CR8","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14699","author":"M Bogojevic","year":"2022","unstructured":"Bogojevic M, Bansal V, Pattan V, Singh R, Tekin A, Sharma M, et al. Association of hypothyroidism with outcomes in hospitalized adults with COVID-19: results from the International SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry. Clin Endocrinol (Oxf). 2022. https:\/\/doi.org\/10.1111\/cen.14699.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"2","key":"4375_CR9","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1213\/00000539-197703000-00030","volume":"56","author":"JM Kim","year":"1977","unstructured":"Kim JM, Hackman L. Anesthesia for untreated hypothyroidism: report of three cases. 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A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"146"}}