Acute myocardial infarction during high-dose methylprednisolone therapy for Graves' ophthalmopathy

Management of Graves' ophthalmopathy includes high-dose glucocorticoids. Glucocorticoids may have many side effects, and therefore their use should always be carefully considered. Here we present the case of a woman who received high doses of methylprednisolone (1 g iv daily) for active Graves' ophthalmopathy, and developed severe hypertension followed by myocardial infarction on the fifth day of treatment. Before the myocardial infarction, the patient was in good condition, normotensive, non-diabetic, non-obese. Except hypothyroidism after radioiodine treatment (euthyroid under substitutional therapy), she suffered from no other diseases. There had been one episode of chest discomfort in her past history. We conclude that myocardial infarction may develop in patients treated with high-dose glucocorticoids for Graves' ophthalmopathy, and increased blood pressure may herald this complication.