Thyroid gland dysfunction in HIV-infected patients
- Melissa Weinberg, MD
Melissa Weinberg, MD
- Assistant Clinical Professor of Medicine
- University of California, San Francisco
- Morris Schambelan, MD
Morris Schambelan, MD
- Professor Emeritus of Medicine
- University of California San Francisco
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.
The infrequency of infectious and infiltrative thyroid disease in HIV-infected patients was illustrated in a retrospective study of 102 autopsy cases in the United States from 1980 to 2007 . Interstitial fibrosis and thyroid hyperplasia were the most common histological findings (5 and 2 percent of cases), whereas an infection was found in fewer than 3 percent, and Kaposi sarcoma of the thyroid gland was present in only one case.
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- GENERAL PRINCIPLES
- GLANDULAR INFECTION AND INFILTRATION
- ALTERATIONS IN THYROID FUNCTION
- Prevalence of thyroid dysfunction
- Effects of medications on thyroid function
- Effects of immune reconstitution inflammatory sydrome (IRIS) on thyroid function
- Assessment and treatment of thyroid function
- SUMMARY AND RECOMMENDATIONS