Objective To analyze the risk factors of PD-1 inhibitor-related thyroid adverse events, so as to provide a basis for reducing the risk of related adverse events.Methods A total of 252 hospitalized patients who received PD-1 inhibitors from January 2020 to October 2023 were included, comprising 106 cases with thyroid adverse events and 146 cases with normal thyroid function. A 1∶1 propensity score matching (PSM) was used to balance confounding factors between groups, and logistic regression analysis was performed to identify risk factors.Results The incidence of thyroid adverse events was 42.1% (106/252), with 20.7% (22/106) presenting significant clinical symptoms, and 2 cases (1.9%) requiring temporary treatment discontinuation. After PSM, 78 matched case pairs were successfully analyzed. Univariate analysis showed significant differences between the two groups in terms of comorbidities, concurrent chemotherapy, and concurrent targeted therapy (P<0.05). Multivariate logistic regression analysis revealed that the comorbidities, concurrent chemotherapy, and concurrent targeted therapy were independent risk factors for PD-1 inhibitor-associated thyroid adverse events (P<0.05).Conclusion Although PD-1 inhibitor-related thyroid adverse events are mostly mild and rarely disrupt treatment, patients with comorbidities, those receiving concurrent chemotherapy, or those treated with TKI-based targeted therapy require enhanced thyroid function monitoring.