A patient with HIV disease may develop active autoimmune thyroiditis during immune restoration associated with highly-active antiretroviral therapy (HAART). It is associated with an expansion of CD4-positive T cells.
Clinical findings:
(1) The patient has advanced HIV disease.
(2) The patient does not have evidence of thyroid disease at baseline.
(3) The patient is started on antiretroviral therapy.
(4) The patient develops signs of a thyroiditis with or without Graves's disease.
(5) The serum is positive for anti-thyroid antibodies.
(6) Hypothyroidism may develop.
(7) Other autoimmune endocrinopathies may be present.
The onset of thyroiditis is often a late manifestation of immune reconstitution, appearing a year or more later.
Differential diagnosis:
(1) tuberculosis or other infection in or around the thyroid gland affected by immune restoration
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