# A Contemporary Multifaceted Narrative Review on Thyroid Dysfunction in People Living with Human Immunodeficiency Virus

## TL;DR

This review explores how thyroid problems are more common in HIV patients, especially those on antiretroviral therapy, and highlights the need for careful monitoring.

## Contribution

The paper provides a comprehensive narrative review of thyroid dysfunction prevalence and management in people living with HIV.

## Key findings

- Subclinical hypothyroidism is the most common thyroid dysfunction in PLWH, with a prevalence up to 40% in those with low CD4 counts.
- Thyroid dysfunction in PLWH is linked to antiretroviral therapy and immune reconstitution inflammatory syndrome.
- Thyroid malignancy risk is elevated in PLWH, necessitating vigilant screening and monitoring.

## Abstract

The use of highly active combined antiretroviral therapy (cART) has increased life expectancy in people living with HIV (PLWH). As a result of ongoing monitoring and surveillance in established HIV out-patient clinics, thyroid dysfunction amongst this population has become increasingly reported. In this narrative review, primary studies, case reports, and meta-analyses published on PubMed, Embase, and Cochrane were analysed. The most reported thyroid dysfunction is subclinical hypothyroidism (SCH). The prevalence of subclinical hypothyroidism was as high as 40% in PLWH with CD4 T-cell count < 350 cells/mm3, which is a level indicating a state of immunosuppression. Some less commonly reported thyroid dysfunctional conditions include overt hyperthyroidism and thyroid malignancy. Reports have linked the development of thyroid dysfunction to the use of cART, leading to immune reconstitution inflammatory syndrome (IRIS), which has also been linked to the development of Grave’s disease (GD). It is also important to check for thyroid malignancy, as PLWH are prone to having a high risk of developing non-AIDS-related or -defining cancer (NADC). Most research suggests symptom-driven monitoring. However, evidence also suggests that monitoring with cART status change, monitoring for patients with significant comorbidities, or with immune reconstitution may be useful. The screening should include Free Thyroxine (FT4), triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) testing. Furthermore, vigilance for Grave’s disease and performing thyroid antibody checks are advised, especially once the reconstitution of T-cells is achieved.