Amiodarone-associated thyroid dysfunction: Current evidence and a practical approach to management

Amiodarone is an effective antiarrhythmic agent but causes thyroid dysfunction in 15-20% of patients, resulting in amiodarone-induced hypothyroidism (AIH) and thyrotoxicosis (AIT).

We performed a narrative review of randomized trials, prospective cohort studies, systematic reviews, and major guideline documents. PubMed and Embase were searched from January 2000 to December 2024 using terms related to amiodarone, thyroid dysfunction, thyrotoxicosis, and hypothyroidism. Priority was given to higher-quality evidence and contemporary society guidelines, including those from the ACC/AHA, ESC, ETA, and ATA.

AIH is generally managed with levothyroxine without routine amiodarone discontinuation. AIT requires phenotypic differentiation and phenotype-directed therapy, with corticosteroids preferred for Type 2 AIT and antithyroid drugs for Type 1 AIT. Decisions regarding amiodarone continuation should be individualized according to thyroid and cardiac risk.

Baseline screening, structured monitoring, and phenotype-directed management allow effective treatment of amiodarone-associated thyroid dysfunction while preserving arrhythmia control.