Amiodarone and thyroid physiology, pathophysiology, diagnosis and management

Abstract

Although amiodarone is considered the most effective antiarrhythmic agent, its use is limited by a wide variety of potential toxicities. The purpose of this review is to provide a comprehensive "bench to bedside" overview of the ways amiodarone influences thyroid function. We performed a systematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2017. Amiodarone was searched using the terms adverse effects, hypothyroidism, myxedema, hyperthyroidism, thyroid storm, atrial fibrillation, ventricular arrhythmia, and electrical storm. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. We included 163 germane references in this review. Because amiodarone is one of the most frequently prescribed antiarrhythmic drugs in the United States, the mechanistic, diagnostic and therapeutic information provided is relevant for practicing clinicians in a wide range of medical specialties.

Keywords: Adverse effects; Amiodarone; Atrial fibrillation; Electrical storm; Hyperthyroidism; Hypothyroidism; Myxedema; Thyroid storm; Ventricular arrhythmia.

Conflict of interest statement

The authors report no relevant conflicts of interest.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Fig. 1.

A composite algorithm for thyroid follow-up and treatment in patients receiving amiodarone.