Determinants and outcome of amiodarone-associated thyroid dysfunction: Thyroid dysfunction and oral amiodarone therapy
Abstract
OBJECTIVE: Amiodarone is frequently associated with thyroid dysfunction. Identifying predictors for amiodarone-associated thyroid dysfunction and assessing treatment outcome may aid clinicians in daily practice. METHODS: We included 303 consecutive patients with amiodarone therapy for cardiac arrhythmias (260 with atrial fibrillation and 43 with ventricular arrhythmias). Thyroid function tests were performed every 6 months. RESULTS: Mean age was 63 ± 12 years and 66% was male. After median follow-up of 3·3 (0·1-24) years, 23 (8%) patients developed amiodarone-associated thyrotoxicosis (incidence rate 1·9 per 100 person years) and 18 (6%) hypothyroidism (incidence rate 1·1 per 100 person years). The only predictor for amiodarone-associated thyrotoxicosis was age <62 years [HR = 2·4 (95% CI 1·0-5·7), P = 0·05]. Predictors for amiodarone-associated hypothyroidism were thyroid stimulating hormone >1·4 mU/l at baseline [HR = 5·1 (95% CI 1·1-22·4), P = 0·03], left ventricular ejection fraction <45% [HR = 3·8 (95% CI 1·1-13·3), P = 0·04] and diabetes mellitus at baseline [HR = 3·3 (95% CI 1·1-10·3), P = 0·04]. Gender was not a predictor for amiodarone-associated thyroid dysfunction. Five out of 12 (42%) patients with thyrotoxicosis exhibited spontaneous normalization of thyroid function on continuation of amiodarone therapy. Mean time to normalization in the total group was 6·2 ± 3·3 months, with no difference between continuing or discontinuing amiodarone (6·6 ± 3·8 vs 5·8 ± 2·8 months, P = 0·5). CONCLUSIONS: During median follow-up of 3·3 years, the incidence of amiodarone-associated thyrotoxicosis was higher compared to hypothyroidism. Only general predictors for amiodarone-associated thyroid dysfunction were observed. Discontinuation of amiodarone did not influence treatment outcome.
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Type 2 AIT typically responds to treatment even if amiodarone therapy is continued, but continuation may lead to a more prolonged time to recovery and a higher rate of future recurrences of AIT.
“In addition, type 2 AIT typically responds to treatment even if amiodarone therapy is continued (585-587), but continuation may lead to a more prolonged time to recovery and a higher rate of future recurrences of AIT (588).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [585]
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Amiodarone-Induced Myxedema Coma in Elderly Patients: A Systematic Review of Case Reports
Alnaeem, M. M., Suleiman, K. H., Mansour, N. H., Alwahsh, B. S., & Nashwan, A. J. (2023) · Cureus · doi:10.7759/cureus.40893 · Cited by 3 · see citing works
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Histological and Morphometric Effect of Amiodarone on the Ovary in Adult Female Albino Rats
Tabou, Z. A. (2023) · Al-Mağallaẗ al-ʻirāqiyyaẗ li-l-ṣaydalaẗ · doi:10.33899/iphr.2023.144294.01067 · Cited by 2 · see citing works
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Amiodarone-induced thyrotoxicosis refractory to medical therapy: A case report
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Prevention and Treatment of Iodine-Induced Thyrotoxicosis
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- Authors
- Ahmed, S., Van Gelder, I. C., Wiesfeld, A. C. P., Van Veldhuisen, D. J., & Links, T. P.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- Links, Thera P.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2011-08-05
- Volume
- 75
- Issue
- 3
- Pages
- 388-394
- ISSN
- 0300-0664 (ISSN-L)
- OpenAlex
- W1715820907
- Cited by
- 72
- References
- 34
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 1 · 2019: 10 · 2018: 9 · 2017: 4 · 2016: 5 · 2015: 2 · 2014: 8 · 2013: 6 · 2012: 2
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- amiodarone, thyroid dysfunction, amiodarone-induced thyrotoxicosis, amiodarone-induced hypothyroidism, cardiac arrhythmias, atrial fibrillation, ventricular arrhythmias, risk factors, thyroid-stimulating hormone, left ventricular ejection fraction, diabetes mellitus, age, drug discontinuation, incidence, treatment outcomes
- MeSH terms
- Adult, Age Factors, Aged, Amiodarone, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Diabetes Mellitus, Female, Follow-Up Studies, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Thyroid Function Tests, Thyroid Gland, Thyrotoxicosis, Thyrotropin, Multivariate Analysis, Databases, Factual, Treatment Outcome, Kaplan-Meier Estimate
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