Incidence and Risk Factors for Amiodarone-Induced Thyroid Dysfunction: A Nationwide Retrospective Cohort Study

Abstract

Background: Amiodarone is an effective anti-arrhythmic drug; however, it is frequently associated with thyroid dysfunction. The aim of this study was to investigate the incidence and risk factor of amiodarone-induced dysfunction in an iodine-sufficient area. Methods: This retrospective cohort study included 27,023 consecutive patients treated with amiodarone for arrhythmia, using the Korean National Health Insurance database. A Cox regression analysis was performed to determine independent risk factors for amiodarone-induced thyroid dysfunction. Results: During a mean follow-up period of 6.4 years, 1326 (4.9%) patients developed thyrotoxicosis and 3121 (11.5%) developed hypothyroidism. The incidence rate of amiodarone-induced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH) was 6.92 and 17.1 per 1000 person-years, respectively. In the multivariate analysis, chronic kidney disease (CKD) [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.06–1.99], and Hashimoto’s thyroiditis (HR 2.00, 95% CI 1.31–3.07) were associated with AIT, while female sex (HR 1.22, 95% CI 1.14–1.32), diabetes (HR 1.14, 95% CI 1.06–1.24), CKD (HR 1.18, 95% CI 1.05–1.34), and Hashimoto’s thyroiditis (HR 2.26, 95% CI 1.66–3.09) were associated with AIH. Conclusions: The incidence of AIH was higher compared with AIT in an area with sufficient iodine intake. Several potential risk factors for AIT and AIH were identified. When amiodarone treatment is considered for patients, particularly those at a high risk of thyroid dysfunction, it is warranted to perform regular thyroid function assessments.