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Thyroid gland dysfunction in the HIV-infected patient

Melissa Weinberg, MD
Morris Schambelan, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Howard Libman, MD, FACP


Early in the AIDS epidemic, endocrine manifestations of HIV infection were often a consequence of opportunistic infections, neoplasms, or concomitant medical conditions. The widespread use of potent antiretroviral therapy (ART) has led to a decline in the incidence of glandular infiltration by opportunistic infections and neoplasms.

This topic addresses the evaluation of thyroid disorders in HIV-infected patients. Issues related to pituitary and adrenal disorders, insulin resistance, bone and calcium disorders, and hypogonadism are discussed elsewhere. (See "Pituitary and adrenal gland dysfunction in HIV-infected patients" and "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 "Hypogonadism in HIV-infected males".)


In general, the approach to thyroid disorders in an HIV-infected patient is similar to that in an uninfected individual. However, HIV infection may also cause changes in thyroid function that are adaptive and do not require treatment. In addition, many of the symptoms and signs of thyroid dysfunction are nonspecific and can overlap with those of non-endocrine disorders that are common in HIV-infected patients. Lastly, some medications used to treat HIV infection and its complications can induce thyroid dysfunction. (See 'Effects of medications' below.)


Infection by a diverse array of organisms, as well as HIV-associated malignancies (eg, Kaposi sarcoma, lymphoma), have been detected in the thyroid gland in patients with AIDS (table 1). Such occurrences were far more common prior to the widespread use of potent antiretroviral therapy (ART), although they may still be observed in patients not receiving ART or who have developed antiretroviral drug resistance.

The infrequency of infectious and neoplastic thyroid disease in HIV-infected patients was illustrated in a retrospective study of 102 autopsy cases in the United States from 1980 to 2007 [1]. Interstitial fibrosis and thyroid hyperplasia were the most common histologic findings (5 and 2 percent of cases, respectively), whereas infection was identified in fewer than 3 percent and Kaposi sarcoma was present in only one case.

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Literature review current through: Nov 2017. | This topic last updated: Oct 23, 2017.
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  1. Cherqaoui R, Shakir KM, Shokrani B, et al. Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients. J Thyroid Res 2014; 2014:364146.
  2. Hommes MJ, Romijn JA, Godfried MH, et al. Increased resting energy expenditure in human immunodeficiency virus-infected men. Metabolism 1990; 39:1186.
  3. Lambert M. Thyroid dysfunction in HIV infection. Baillieres Clin Endocrinol Metab 1994; 8:825.
  4. Sellmeyer DE, Grunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev 1996; 17:518.
  5. Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev 1982; 3:164.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Dev N, Sahoo R, Kulshreshtha B, et al. Prevalence of thyroid dysfunction and its correlation with CD4 count in newly-diagnosed HIV-positive adults--a cross-sectional study. Int J STD AIDS 2015; 26:965.
  11. Silva GA, Andrade MC, Sugui Dde A, et al. Association between antiretrovirals and thyroid diseases: a cross-sectional study. Arch Endocrinol Metab 2015; 59:116.
  12. Hatzl M, Öllinger A, Geit M, et al. Thyroid screening in HIV-infected patients with antiretroviral therapy. Wien Klin Wochenschr 2015; 127:601.
  13. Ji S, Jin C, Höxtermann S, et al. Prevalence and Influencing Factors of Thyroid Dysfunction in HIV-Infected Patients. Biomed Res Int 2016; 2016:3874257.
  14. 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.
  15. 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.
  16. 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.
  17. Crum NF, Ganesan A, Johns ST, Wallace MR. Graves disease: an increasingly recognized immune reconstitution syndrome. AIDS 2006; 20:466.
  18. 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.