HAART Therapy & Graves Disease

Feb 21, 2009

Good day Dr, McGowan,

I have had Graves Disease for many years (over 15 to be exact). I was just diagnosed + last month with a CD4 count of 230 and a VL of 7K. I started HAART (Truvada, Norvir, Reyataz) several weeks ago and was wondering if my Synthroid med( taking 1 088 mcg pill a day) might be conflicting or interfering somehow with my therapy since I've noticed my feet and sometimes my hands and arms tingling/falling asleep much more often since starting the HIV meds. No family history of diabetes or symptoms of it either. Do have a couple of herniated discs in my back however so I was thinking that could very well be the deal too. Can you tell me what might be happening or if I should be concerned? My specialist knows of my prior disease but hasn't said anything one way or the other about what or if any conflict there may or may not be with the meds. Thank you much in advance and I appreciate your response very much.

Response from Dr. McGowan

Thanks for your question.

Use of Synthroid and Norvir together may result in loss of Synthroid (levothyroxine) effectiveness. Your should have your TSH level checked to see if you need a dose adjustment.

There have been reports of flair-ups of Graves Disease in people who have an increase in their CD4 counts after starting HAART. This is an immune reconstitution effect. Since you are on synthroid, you have probabaly had ablation (removal by surgery or radioactive iodine) of your thyroid, which would not put you at risk for a Graves flair up.

Best, Joe