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HIV & Thyroid Disease

The thyroid is responsible for producing the hormones thyroxine and triiodothyronine, which influence bone development, growth, brain function, neural development and metabolism. Therefore, thyroid disease may affect many aspects of a patient's health. An imbalance of thyroid hormones can be considered primary, meaning it results from an abnormality in the thyroid gland itself, or secondary, meaning it stems from problems with the pituitary gland or the hypothalamus, which both play import roles in thyroid function. If thyroid disease results from an overactive thyroid, it is called hyperthyroidism. If the thyroid is not producing enough hormones, the condition is called hypothyroidism.

Prevalence of Thyroid Disease in People Living With HIV

Thyroid disease appears to be equally common in HIV positive and HIV negative individuals; however, people taking antiretroviral therapy to treat HIV are more likely to exhibit abnormal thyroid function in laboratory testing. More importantly, some medications used for treating hypothyroidism and hyperthyroidism are known to interact with antiretrovirals, so special care is needed when treating thyroid disease in HIV patients. More research is needed to establish a definitive link between thyroid dysfunction and HIV. Routine screening for thyroid disease is not recommended for HIV patients unless symptoms manifest.

Symptoms and Diagnosis of Thyroid Disease in People Living With HIV

Thyroid disease may produce numerous symptoms that are common to other illnesses. The only way to diagnose thyroid dysfunction is through blood analysis. Common symptoms of hypothyroidism include:

-Memory impairment
-Fatigue
-Depression
-Increased sensitivity to cold
-Decreased heart rate
-Constipation
-Thinning hair
-Dry skin
-Heavy or irregular menstrual periods
-Unexplained weight gain
-Pain, stiffness and swelling of the muscles and joints
-Elevated blood cholesterol
-Puffy face
-Muscle weakness
-Hoarseness

Common symptoms of hyperthyroidism include:

-Unexplained weight loss
-Thinning skin
-Rapid or irregular heartbeat
-Sleeping difficulties
-Increased appetite
-Muscle weakness
-Anxiety and irritability
-Fatigue
-Trembling in the hands and fingers
-Increased sensitivity to heat
-Sweating
-Frequent bowel movements
-Brittle hair
-Irregular menstrual patterns
-An enlarged thyroid gland, which manifests as swelling at the base of the neck. This symptom is also called a goiter.

Treatment of Thyroid Disease in People Living with HIV

The first line of treatment for hypothyroidism is oral hormone replacement, and hyperthyroidism is usually treated with oral medications that limit the actions of the thyroid gland. In severe cases, surgery may be need to remove the thyroid completely or partially. No specific guidelines have been established for treating thyroid disease in patients with HIV; however, a few cases of severe interactions between the drug levothyroxine and some antiretrovirals including indinivir and lopinavir/ritonavir have been documented. Doctors and patients should check the www.hiv-druginteractions.org/Interactions.aspx">latest information about antiretroviral drug interactions before beginning treatment for thyroid disease, and patients should be carefully monitored for adverse effects when starting a new drug.

References

http://myhivclinic.org/thyroid-disease
http://journals.lww.com/aidsonline/Fulltext/2006/05120/Dramatic_interaction_between_levothyroxine_and.22.aspx
http://www.ncbi.nlm.nih.gov/pubmed/17638201