PMC4006358_01
Changes in TSH, CK and ALT levels before and after MK-3475 therapy. The trends of serum levels of TSH (Normal range: 0.5-5 mIU/L) , CK (normal range: 55-170 U/L) and ALT (normal range: 10-50 U/L) were plotted. Time 0 represents the first dose of MK-3475. Time for ipilimumab treatment and radiation therapy are indicated as well. Ipi: ipilimumab.
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F1
He was hospitalized following laboratory results that were significant for elevated transaminases: aspartate transaminase (AST) 858 units per liter (reference range: 10-50), and alanine aminotransferase (ALT) 289 units per liter (reference range: 10-50) (Figure 1). The levels of alkaline phosphatase, bilirubin and gamma-glutamyl transferase in the blood were normal but the level of creatine kinase (CK) was significantly elevated at 30980 units per liter (reference range, 55-170) (Figure 1), supporting the diagnosis for rhabdomyolysis rather than hepatic injury. Further laboratory testing revealed severe hypothyroidism; TSH was 145 and peaked at 187.82 mIU per liter (reference range 0.5-5) (Figure 1) with undetectable free thyroxine.