Recurrent Adams-Stokes attacks treated by intravenous corticosteroids in a 48 year old thyroidectomized female

A 48-year old female patient, thyroidectomized 4 weeks previously, returns as an emergency with arterial hypertension (AH), atrial fibrillation, cardio congestive failure; after a common therapy which included cardiotonics and diuretics, the patient's condition was improved, but quite unexpectedly she developed 5 cardiac syncopes within 3 hours (pulse and arterial pressure fall, electric asystole) with a dramatic Adams-Stokes syndrome requiring external resuscitation maneuvers. High speed infusion with glucose and ascorbic acid 2,500 mg given intravenously appeared to have stopped the imminence of an attack, but only after corticosteroids both in bolus and infused a stable sinusal rhythm was obtained. Intensive corticotherapy was preferred to sympathicomimetic drugs which are at risk for ventricular arrhythmia. Corticosteroids are the therapy of choice because they prevented the production of oxygen derived free radicals whose accumulation causes bradycardia and finally heart arrest.