Thyroid gland dysfunction in the HIV-infected patient
- 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
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 . 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GLANDULAR INFILTRATION
- ALTERATIONS IN THYROID FUNCTION
- Prevalence of thyroid dysfunction
- Effects of medications
- Effects of immune reconstitution inflammatory syndrome
- ASSESSMENT OF THYROID FUNCTION
- Thyroid nodules
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS