Increased heart rhythm in response to high-dose intravenous methylprednisolone pulse therapy of moderate-to-severe Graves’ orbitopathy

Authors

DOI:

https://doi.org/10.20883/medical.e774

Keywords:

Graves’ ophthalmopathy, Graves’ disease, glucocorticoids, heart rate

Abstract

Background. Intravenous glucocorticoids pulses administration is the main therapeutic option in the treatment of Graves’ orbitopathy. Such therapy could relate to the multiple adverse effects. The aim of the study is evaluation the influence of intravenous methylprednisolone (IVMP) pulse therapy on the heart rhythm (HR) changes in patients with active, moderate-to-severe Graves’ Orbitopathy (GO).

Methods. We studied 20 patients with moderate-to-severe GO. All patients received 12 IVMP pulses (6x500 mg plus 6x250mg) at equal time intervals in a weekly schedule. We performed Holter ECG monitoring for 3 consecutive days (the day before, the day of IVMP and day after IVMP) to monitor HR and arrhythmias. We compared changes in HR between these 3 days and set time interval when the alteration was significant. This evaluation was performed during the 1st, 6th and 12th IVMP pulse.

Results. Increased HR, in comparison with the day before, was registered on the day of IVMP administration. The most significant increase in HR started 5 hours (h) after a pulse administration and lasted 12 h. There were no significant differences in HR between the day before and the day after IVMP. We did not notice any major adverse cardiac events including severe arrhythmias.

Conclusions. IVMP therapy is associated with increased HR, that occurs a few hours after infusion, lasts several hours and is transient. 

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References

Bartalena L, Kahaly GJ, Baldeschi L, Dayan CM, Eckstein A, Marcocci C, Marinò M, Vaidya B, Wiersinga WM; EUGOGO †. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol. 2021 Aug 27;185(4):G43-G67. doi: 10.1530/EJE-21-0479. PMID: 34297684.

Miśkiewicz P, Kryczka A, Ambroziak U, Rutkowska B, Główczyńska R, Opolski G, Kahaly G, Bednarczuk T. Is high dose intravenous methylprednisolone pulse therapy in patients with Graves' orbitopathy safe? Endokrynol Pol. 2014;65(5):402-13. doi: 10.5603/EP.2014.0056. PMID: 25301492.

Pishgahi M, Dadkhahfar S, Robati RM, Kheradmand Z, Shahidi-Dadras M, Zargari O, Elpern DJ. Electrocardiographic changes after high-dose corticosteroid pulse therapy in pemphigus patients. J Dermatolog Treat. 2018 Dec;29(8):802-805. doi: 10.1080/09546634.2018.1466980. Epub 2018 May 7. PMID: 29668335.

Fujimoto S, Kondoh H, Yamamoto Y, Hisanaga S, Tanaka K. Holter electrocardiogram monitoring in nephrotic patients during methylprednisolone pulse therapy. Am J Nephrol. 1990;10(3):231-6. doi: 10.1159/000168087. PMID: 1696428.

Marcocci C, Watt T, Altea MA, Rasmussen AK, Feldt-Rasmussen U, Orgiazzi J, Bartalena L; European Group of Graves' Orbitopathy. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy: a questionnaire survey among members of the European Thyroid Association. Eur J Endocrinol. 2012 Feb;166(2):247-53. doi: 10.1530/EJE-11-0779. Epub 2011 Nov 4. PMID: 22058081.

Vasheghani-Farahani A, Sahraian MA, Darabi L, Aghsaie A, Minagar A. Incidence of various cardiac arrhythmias and conduction disturbances due to high dose intravenous methylprednisolone in patients with multiple sclerosis. J Neurol Sci. 2011 Oct 15;309(1-2):75-8. doi: 10.1016/j.jns.2011.07.018. Epub 2011 Aug 9. PMID: 21831398.

Belmonte MA, Cequiere A, Roig‑Escofet D. Severe ventricular arrhythmia after methylprednisolone pulse therapy in rheumatoid arthritis. J Rheumatol [Internet]. 1986 Apr;13(2):477–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3723518

Kumari R, Uppal SS. First report of supraventricular tachycardia after intravenous pulse methylprednisolone therapy, with a brief review of the literature. Rheumatol Int. 2005 Nov;26(1):70-3. doi: 10.1007/s00296-005-0589-7. Epub 2005 Feb 23. PMID: 15726372.

Tvede N, Nielsen LP, Andersen V. Bradycardia after high-dose intravenous methylprednisolone therapy. Scand J Rheumatol. 1986;15(3):302-4. doi: 10.3109/03009748609092597. PMID: 3798047.

McLuckie AE, Savage RW. Atrial fibrillation following pulse methylprednisolone therapy in an adult. Chest. 1993 Aug;104(2):622-3. doi: 10.1378/chest.104.2.622. PMID: 8339660.

Reddy V, Taha W, Kundumadam S, Khan M. Atrial fibrillation and hyperthyroidism: A literature review. Indian Heart J. 2017 Jul-Aug;69(4):545-550. doi: 10.1016/j.ihj.2017.07.004. Epub 2017 Jul 5. PMID: 28822529; PMCID: PMC5560908.

Yamamura K, Ohga S, Nishiyama K, Doi T, Tsutsumi Y, Ikeda K, Fujishima A, Takada H, Hara T. Recurrent atrial fibrillation after high-dose methylprednisolone therapy in a girl with lupus-associated hemophagocytic syndrome. Lupus. 2011 Jul;20(8):871-5. doi: 10.1177/0961203310392429. Epub 2011 Mar 17. PMID: 21415254.

Cohen IJ. Cardiovascular collapse after high dose methylprednisolone. Pediatr Hematol Oncol. 1993 Jul-Sep;10(3):v-vii. doi: 10.3109/08880019309029486. PMID: 8217535.

Schult M, Löhmann D, Knitsch W, Kuse ER, Nashan B. Recurrent cardiocirculatory arrest after kidney transplantation related to intravenous methylprednisolone bolus therapy. Transplantation. 1999 Jun 15;67(11):1497-8. doi: 10.1097/00007890-199906150-00022. PMID: 10385096.

Bocanegra TS, Castañeda MO, Espinoza LR, Vasey FB, Germain BF. Sudden death after methylprednisolone pulse therapy. Ann Intern Med. 1981 Jul;95(1):122. doi: 10.7326/0003-4819-95-1-122_1. PMID: 7247116.

Miskiewicz P, Milczarek-Banach J, Bednarczuk T, Opolski G, Glowczynska R. Blood Pressure Profile and N-Terminal-proBNP Dynamics in Response to Intravenous Methylprednisolone Pulse Therapy of Severe Graves' Orbitopathy. Int J Mol Sci. 2018 Sep 26;19(10):2918. doi: 10.3390/ijms19102918. PMID: 30261581; PMCID: PMC6213036.

Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, Brown JP, Cohen A, Kim H. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug 15;9(1):30. doi: 10.1186/1710-1492-9-30. PMID: 23947590; PMCID: PMC3765115.

Weiss JN, Qu Z, Shivkumar K. Electrophysiology of Hypokalemia and Hyperkalemia. Circ Arrhythm Electrophysiol. 2017 Mar;10(3):e004667. doi: 10.1161/CIRCEP.116.004667. PMID: 28314851; PMCID: PMC5399982.

Young SM, Lim AYN, Lang SS, Lee KO, Sundar G. Efficacy and safety of pulsed intravenous methylprednisolone in early active thyroid eye disease. Orbit. 2019 Oct;38(5):362-369. doi: 10.1080/01676830.2018.1553189. Epub 2018 Dec 12. PMID: 30540214.

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Published

2023-02-09

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Original Papers

How to Cite

1.
Gutowska K, Wojdyńska Z, Szewczyk S, Milczarek-Banach J, Miśkiewicz P. Increased heart rhythm in response to high-dose intravenous methylprednisolone pulse therapy of moderate-to-severe Graves’ orbitopathy. JMS [Internet]. 2023 Feb. 9 [cited 2024 Oct. 4];92(1):e774. Available from: https://jms.ump.edu.pl/index.php/JMS/article/view/774
Received 2022-11-16
Accepted 2022-12-23
Published 2023-02-09