Jonathan S. LoPresti, MD, PhD; Jeffrey C. Fried, MD; Carole A. Spencer, PhD; John T. Nicoloff, MD
Study Objective: To determine alterations in serum thyroid hormone indices in patients with human immunodeficiency virus (HIV) infection.
Design: Prospective, single-blind study.
Setting: Large metropolitan hospital where 20% of all patients with the acquired immunodeficiency syndrome (AIDS) in Los Angeles are treated.
Patients: Twenty-six inpatients with bronchoscopy-proven Pneumocystis carinii pneumonia and AIDS. Outpatients included 10 persons seropositive for HIV, 10 with AIDS-related complex, and 10 with AIDS.
Main Results: There were 19 survivors and 7 nonsurvivors of P. carinii infection. Serum triiodothyronine (T3) values generally remained normal until hospitalization, with nonsurvivors having lower values than survivors (0.56 ± 0.1 nmol/L compared with 1.3 ± 0.1 nmol/L, P < 0.002, respectively). Reverse triiodothyronine (rT3) levels were low in persons with AIDS-related complex (0.21 ± 0.02 nmol/L, P < 0.001) and in AIDS outpatients (0.17 ±0.02 nmol/L, P < 0.001). Normalization of rT3 occurred after patients were hospitalized (0.28 ± 0.01 nmol/L). Serum thyroxinebinding globulin values rose with progression of HIV infection (seropositive, 369.7 ± 18.1 nmol/L, P < 0.005; AIDS-related complex, 419.1 ± 37.0 nmol/L, P < 0.005; AIDS, 423.3 ± 31.9 nmol/L, P < 0.005; survivors, 476.3 ± 24.6 nmol/L, P < 0.001), whereas nonsurvivors had normal values. All values are compared with normal values (T3, 2.3 ± 0.04 nmol/L; rT3, 0.28 ± 0.01 nmol/L; thyroxinebinding globulin, 288.2 ± 6.9 nmol/L).
Conclusions: Infection with HIV produces unique alterations in thyroid function. A progressive decline in rT3 and elevation in thyroxine-binding globulin accompany advancing HIV infection. The persistence of a normal T3 despite progression of HIV infection may contribute to weight loss. A low serum T3 on admission correlates with mortality.
Jonathan S. LoPresti, Jeffrey C. Fried, Carole A. Spencer, John T. Nicoloff. Unique Alterations of Thyroid Hormone Indices in the Acquired Immunodeficiency Syndrome (AIDS). Ann Intern Med. 1989;110:970–975. doi: 10.7326/0003-4819-110-12-970
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Published: Ann Intern Med. 1989;110(12):970-975.
HIV, Infectious Disease.
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