Pembrolizumab and/ or steroids leading to thyroid/ adrenal issues

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I’d be immensely grateful for any advice or shared experiences. Thanks in advance!

I am wondering whether my history of Pembrolizumab, a pneumonitis side effect then a lot of steroids has caused either thyroid or adrenal problems. These have never had blood test checks since late 2022. I will explain my story then my current symptoms below: 

After 6 out of 8 scheduled Pembros April- December ‘22 following Stsge 3B groin dissection I suffered a side effect of pneumonitis in Jan ‘23. 2 weeks on a respiratory ward then discharged on 60mg /day steroids weaning by 10mg each week.

Putting to one side the miniscule support from my oncology team I had several recurrences during 2023 where I had to self diagnose and then self prescribe my steroid “ weaning starter quantity “. Bizarre I know but it is very hard also to get urgent GP appointments.

I had several recurrences hence a lot of steroids then September to December ‘23 regained my fitness and social life. But on 16/12/23 I ended up in A&E - fainted, chest infection, antibiotics prescribed. Back at A&E 27/12; still infection markers ( via blood tests), more antibiotics. GP early January, sputum test, bad haemophilus influenzae confirmed, very high doses of a stronger antibiotic. 3rd visit to A&E last week ( 15 hours!). All tests clear. “ You can go home” to which I replied “but I still feel ill” ! I felt wretched. Will explain symptoms below.

Did some research plus spoke to MacMillan Helpline on Friday. I now have a blood test arranged ( in over a week’s time) but also have my rescheduled 6 monthly PET scan on Thursday this week and review with my plastic surgeon on Friday. My symptoms - even though A&E last week said bloods, XRay, ECG, even a CT scan were fine - are:

- body feels cold, especially in bed in the early hours

- very fatigued a lot of the time

- drooling ( saliva)

- feeling a bit woozy in crowded places ( hence dread the hospital visits later this week)

- very thirsty a lot of the time but……….….….

my sats are fine, my appetite is fine. I just basically don’t feel myself and do wonder, since they haven’t been checked for such a long time, whether I have a thyroid or adrenal issue. Thanks again for any advice or shared experiences. Thanks !

  • Hi Wurlitzer, 

    sounds like your going thru it. I’ve now got Adrenal problems so your not alone.

    i had 2 doses of Nivo/Ipilimumab and after my 2nd dose I got Liver Hepatitis and an underactive Thyroid and went on steroids for 11 weeks. Cured the Hepatitis but left me with my Adrenal glands not producing Cortisol. Now on Steroids for life to replace the Cortisol.the Thyroid seems to have settled down but still suffering from Fatigue. Glad the headaches went. I had a MRI on my head to check the gland there and now waiting to see someone at Endocrinology to discuss a way forward.

    i would enquire about seeing someone from that department.

    good luck. I hope you get some answers soon  

  • Hi Wurlitzer 

    my husband also had problems after his second dose of Pembro in August 2021 and his Adrenal glands were damaged and no ability to produce Cortisol which led to fatigue, dizziness and hardly able to keep his eyes open. Diagnosed with Addisons disease.

    we did get to see an Endocrinologist who explained how to manage the disease and explained it would be for life. So far, fingers crossed we’ve only had a few occasions where we’ve had to take extra tablets and think we know how to handle it.

    surprised A and E didn’t test for cortisol levels, maybe they did and there’s some other reason for your fatigue.

    Good luck to you all. We have finished treatment, dermatology appointments have gone to plan, just had another CT scan and back to hospital on Thursday to get results, the journey continues

  • Thanks. I have a thyroid/ cortisol blood test via my GP tomorrow. According to her screen I haven’t had these blood tested since early 2022. More than annoying as I was on Pembro up to December 2022 and then under the continued care of Oncology through all of 2023 whilst having side effect recurrences and many steroids. I do sense that levels of care are a postcode lottery.