CD4 and thyroid gland disorder: PD-AML 2 exhibited a period of thyrotoxicosis preceding overt hypothyroidism, previously described with anti-PD-1-induced thyroiditis.40 41 PD-AML 3, who developed central diabetes insipidus after four cycles, had pronounced CD8+ and CD4+ clonal T cell expansions that coincided with the irAE and were undetectable prior to Pembrolizumab (figure 2E).