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.
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.
- Hommes MJ, Romijn JA, Godfried MH, et al. Increased resting energy expenditure in human immunodeficiency virus-infected men. Metabolism 1990; 39:1186.
- Lambert M. Thyroid dysfunction in HIV infection. Baillieres Clin Endocrinol Metab 1994; 8:825.
- Madeddu G, Spanu A, Chessa F, et al. Thyroid function in human immunodeficiency virus patients treated with highly active antiretroviral therapy (HAART): a longitudinal study. Clin Endocrinol (Oxf) 2006; 64:375.
- Sellmeyer DE, Grunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev 1996; 17:518.
- Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev 1982; 3:164.
- LoPresti JS, Fried JC, Spencer CA, Nicoloff JT. Unique alterations of thyroid hormone indices in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1989; 110:970.
- Grunfeld C, Pang M, Doerrler W, et al. Indices of thyroid function and weight loss in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Metabolism 1993; 42:1270.
- Beltran S, Lescure FX, Desailloud R, et al. Increased prevalence of hypothyroidism among human immunodeficiency virus-infected patients: a need for screening. Clin Infect Dis 2003; 37:579.
- Nelson M, Powles T, Zeitlin A, et al. Thyroid dysfunction and relationship to antiretroviral therapy in HIV-positive individuals in the HAART era. J Acquir Immune Defic Syndr 2009; 50:113.
- Carella C, Mazziotti G, Amato G, et al. Clinical review 169: Interferon-alpha-related thyroid disease: pathophysiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab 2004; 89:3656.
- Jubault V, Penfornis A, Schillo F, et al. Sequential occurrence of thyroid autoantibodies and Graves' disease after immune restoration in severely immunocompromised human immunodeficiency virus-1-infected patients. J Clin Endocrinol Metab 2000; 85:4254.
- Gilquin J, Viard JP, Jubault V, et al. Delayed occurrence of Graves' disease after immune restoration with HAART. Highly active antiretroviral therapy. Lancet 1998; 352:1907.
- Crum NF, Ganesan A, Johns ST, Wallace MR. Graves disease: an increasingly recognized immune reconstitution syndrome. AIDS 2006; 20:466.
- Rasul S, Delapenha R, Farhat F, et al. Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy. AIDS Res Treat 2011; 2011:743597.
- GENERAL PRINCIPLES
- GLANDULAR INFECTION AND INFILTRATION
- ALTERATIONS IN THYROID FUNCTION
- 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