When starting amiodarone, which baseline tests are appropriate as part of monitoring?

• A. Baseline thyroid function tests and baseline liver function tests
• B. Baseline only heart rate
• C. No monitoring required
• D. Only ECG

Answer: (A)

Amiodarone can affect both the thyroid and the liver, so baseline testing of these organs is essential before starting therapy. Check thyroid function with TSH and free T4 to identify any preexisting thyroid disease and to provide a reference point for future monitoring, since amiodarone can cause both hypothyroidism and hyperthyroidism. Check liver function with enzymes like ALT/AST (and bilirubin) to establish hepatic status and to detect hepatotoxicity that can develop during treatment. These two areas are the primary concerns for baseline safety assessment with amiodarone, making them the best pair to start monitoring. While an ECG is important for rhythm and conduction monitoring, it does not address the potential thyroid or liver toxicities, which is why the combination of baseline thyroid and liver tests is the most appropriate choice.