In the early AIDS epidemic, the diverse endocrine manifestations of HIV infection were more often a consequence of opportunistic infections (OIs), neoplasms, or concomitant systemic illness. The widespread use of potent antiretroviral therapy (ART) has led to a decline in the incidence of glandular infiltration by OIs and neoplasms and has generated increased attention toward the metabolic complications of HIV therapy, including insulin resistance, dyslipidemia, and alterations in body fat distribution.
This topic review will address the assessment and management of thyroid disorders in patients with HIV/AIDS. Issues related to pituitary and adrenal disorders, insulin resistance, bone and calcium disorders, and changes in sex hormones are discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy" and "Treatment of HIV-associated lipodystrophy" and "Bone and calcium disorders in HIV-infected patients" and "Pituitary and adrenal gland dysfunction in HIV-infected patients".)
In general, the diagnosis and treatment of thyroid disorders in a patient with HIV infection does not differ from that in an immunocompetent individual. There are, however, some special considerations. HIV infection may cause changes in thyroid function that are adaptive and do not require treatment. Furthermore, many of the signs and symptoms of thyroid dysfunction are nonspecific and can overlap with other non-endocrine disorders that are common in HIV-infected patients. Finally, some medications that are used to treat HIV infection and its complications can induce thyroid dysfunction (table 1).
GLANDULAR INFECTION AND INFILTRATION
Infection by a diverse array of organisms, as well as HIV-associated malignancies (ie, Kaposi's sarcoma and lymphoma), have been detected in the thyroid gland (table 2). Such occurrences were far more common prior to the widespread introduction of potent ART, although they may still be observed in patients not receiving ART or who have antiretroviral drug resistant infection.
Tissue is generally required for a definitive diagnosis. Fine needle aspiration (FNA) biopsy of the thyroid is safe, effective, and widely available. Standard functional testing should also be performed since clinically significant thyroid dysfunction may accompany glandular infection or infiltration.