Abstract
Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment for the active phase of moderate to severe Graves' orbitopathy (GO). However, acute and severe liver damage has been reported during and after IVMP therapy. In this retrospective study, we investigated risk factors for liver dysfunction during and after IVMP therapy based on 175 Japanese patients with moderate to severe GO and treated at our center between 2003 and 2011. The results showed that seven patients developed severe liver dysfunction with elevated serum alanine aminotransferase (ALT > 300 U/L). Mild (40–100 U/L) and moderate (100–300 U/L) increases of ALT occurred in 62 patients (35%) and 10 patients (6%), respectively. Liver dysfunction was more frequently observed in males, in patients receiving high-dose methylprednisolone, and patients aged over 50 years. Preexistent viral hepatitis was significantly associated with liver dysfunction (65% in patients positive for hepatitis B core antibody and patients positive for hepatitis C virus antibodies). Our study confirmed the association of liver dysfunction with IVMP during and after treatment. It suggests that, in patients with GO, evaluation of preexisting risk factors—including viral hepatitis—and careful weekly monitoring of liver function during IVMP therapy and monthly thereafter for 12 months are warranted.
Highlights
Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment for patients with active-phase moderate to severe Graves’ orbitopathy (GO) [1]
IVMP pulse therapy is widely used as the first-line treatment for active moderate-to-severe orbitopathy, severe related side effects have been reported, the most common of which is hepatotoxicity
In the recent review by Zang et al [9], the morbidity and mortality of GO patients treated with IVMP pulse therapy were 6.5% and 0.6%, respectively
Summary
Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment for patients with active-phase moderate to severe Graves’ orbitopathy (GO) [1]. Acute and severe liver damage has been reported after pulse therapy, with a roughly estimated morbidity and mortality of 0.8% and 0.3%, respectively [4]. The cumulative dose of IVMP in four patients with fatal liver failure was 8.3–15 g [4, 5] but slightly higher in three patients who died (10.8 ± 3.6 g) than in four patients who recovered (7.9 ± 2.9 g) [4]. The causes of IVMP-associated liver damage are incompletely understood.
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