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Objective: To report cardiac outcomes after total thyroidectomy for amiodarone‐induced thyrotoxicosis according to the baseline left ventricular ejection fraction in a tertiary referral center. Study Design: Retrospective, monocentric. Setting: The tertiary health care system. Methods: Patients who underwent total thyroidectomy for amiodarone‐induced thyrotoxicosis between 2010 and 2020 with age >18 and available preoperative left ventricular ejection fraction were included in this study. Patients were dichotomized into: group 1 with left ventricular ejection fraction ≥40% (mildly reduced/normal ejection fraction), and group 2 with left ventricular ejection fraction <40% (reduced ejection fraction). Results: There were 34 patients in group 1 and 17 to group 2. The latter were younger (median 58.4 [Q1‐Q3 48.0‐64.9] vs. 69.8 years in group 1 [59.8‐78.3], p =.0035) and they presented more cardiomyopathy (58.8 vs. 26.5%, p =.030). Overall, the median time until surgery referral was 3.1 [1.9‐7.1] months and 47.1% underwent surgery after restoration of euthyroidism. Surgical complications accounted for 7.8%. In group 2, the median left ventricular ejection fraction was significantly improved after surgery (22.5 [20.0‐25.0] vs. 29.0% [25.3‐45.5], p =.0078). Five‐year cardiac mortality was significantly higher in group 2 (p <.0001): 47.0% died of cardiac causes versus 2.9% in group 1. A baseline left ventricular ejection fraction <40% and a longer time until surgery referral were significantly associated with cardiac mortality (multivariable Cox regression analysis, p =.015 and.020, respectively). Conclusion: These results reinforce the idea that surgery, if chosen, should be performed quickly in patients with left ventricular ejection fraction <40%. [ABSTRACT FROM AUTHOR]