Heart rhythm · 2025
Association between amiodarone and thyrotoxicosis in patients with atrial fibrillation and hypothyroidism.
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Ryan Doaa, Gershinsky Romy, Gronich Naomi, Yahav Amir, Barnett-Griness Ofra, Schliamser Jorge E, Saliba Walid, Danon Asaf
Аннотация
BACKGROUND: Evidence remains scarce on the risk of transition from hypothyroidism to thyrotoxicosis in patients treated with amiodarone.
OBJECTIVE: This study aimed to assess the association between amiodarone and thyrotoxicosis in patients with atrial fibrillation (AF) and concomitant diagnosis of hypothyroidism.
METHODS: We conducted a population-based retrospective cohort study using the Clalit Health Services database, the largest health care provider in Israel. Patients with a new diagnosis of AF between 2010 and 2023 were used to identify 2 separate cohorts defined based on their thyroid function status (hypothyroidism cohort vs normal thyroid cohort). Using Cox proportional hazard regression, exposure to amiodarone was examined as a time-dependent variable, allowing subjects to transfer from one exposure group to another during follow-up.
RESULTS: A total of 23,854 patients with AF were included in the hypothyroidism cohort, with thyrotoxicosis diagnosed during follow-up in 107 patients (66 of 8212 amiodarone users and 41 of 15,622 non-users), reflecting a crude incidence rate of 3.43 and 0.63 per 1000 person-years in amiodarone users and non-users, respectively. In this cohort, amiodarone was independently associated with increased risk of thyrotoxicosis with an adjusted hazard ratio of 5.18 (95% confidence interval [CI], 3.48-7.69). The magnitude of amiodarone effect was higher in patients with normal thyroid function, with an incidence rate of 19.78 and 1.14 per 1000 person-years in amiodarone users and non-users, respectively, and an adjusted-hazard ratio of 15.02 (95% confidence interval, 13.56-16.64).
CONCLUSION: Although the magnitude of the effect of amiodarone on the risk of thyrotoxicosis is lower in patients with hypothyroidism, the risk remains elevated and mandates caution.
OBJECTIVE: This study aimed to assess the association between amiodarone and thyrotoxicosis in patients with atrial fibrillation (AF) and concomitant diagnosis of hypothyroidism.
METHODS: We conducted a population-based retrospective cohort study using the Clalit Health Services database, the largest health care provider in Israel. Patients with a new diagnosis of AF between 2010 and 2023 were used to identify 2 separate cohorts defined based on their thyroid function status (hypothyroidism cohort vs normal thyroid cohort). Using Cox proportional hazard regression, exposure to amiodarone was examined as a time-dependent variable, allowing subjects to transfer from one exposure group to another during follow-up.
RESULTS: A total of 23,854 patients with AF were included in the hypothyroidism cohort, with thyrotoxicosis diagnosed during follow-up in 107 patients (66 of 8212 amiodarone users and 41 of 15,622 non-users), reflecting a crude incidence rate of 3.43 and 0.63 per 1000 person-years in amiodarone users and non-users, respectively. In this cohort, amiodarone was independently associated with increased risk of thyrotoxicosis with an adjusted hazard ratio of 5.18 (95% confidence interval [CI], 3.48-7.69). The magnitude of amiodarone effect was higher in patients with normal thyroid function, with an incidence rate of 19.78 and 1.14 per 1000 person-years in amiodarone users and non-users, respectively, and an adjusted-hazard ratio of 15.02 (95% confidence interval, 13.56-16.64).
CONCLUSION: Although the magnitude of the effect of amiodarone on the risk of thyrotoxicosis is lower in patients with hypothyroidism, the risk remains elevated and mandates caution.