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How to Thwart a Thyroid Problem

An Untreated Condition of the Butterfly-Shaped Thyroid Gland Can Have a Significant Impact on Your Body and Daily Life. Find Out How to Spot the Signs and What You Can Do About It.

Winter 2014

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How to Thwart a Thyroid Problem

Hundreds of millions of people around the world have one. As do roughly one out of every 10 Canadians -- although half of us aren't aware of it. We're talking about thyroid problems.

A thyroid problem can be so unobtrusive that you don't even notice it, or it can affect the way you look, feel and act. When the small gland at the base of the neck doesn't function properly, it can contribute to fertility problems, heart disease, diabetes, arthritis and many other health problems. It can also affect your mood: An overactive thyroid can make you anxious and irritable, while an underactive thyroid can drag you down, making you feel tired and depressed.

It seems that people with HIV are slightly more likely than the general population to develop a thyroid problem, though most will never experience a thyroid problem of any kind. All the same, it's one of those things that's worth being aware of because treatments exist to manage such conditions effectively. The better equipped you are to detect signs of imbalance, the sooner you can have it checked out and, if need be, take steps to redress the imbalance.

Here are two stories that highlight thyroid problems that can affect people living with HIV. Selena's hypothyroidism is more common and Patrick's Graves' disease, relatively uncommon.

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Selena, 32, was first diagnosed with HIV five years ago and started taking antiretroviral therapy (ART) within a few months of her diagnosis. During her last visit to the HIV clinic, she reported feeling fatigued and sluggish and had gained 10 pounds over the past several months despite a stable diet. Blood tests confirmed that she had an underactive thyroid (hypothyroidism), which may have been due to HIV or to the HIV medications she was taking. To treat the condition, her doctor prescribed a thyroid hormone supplement. After two months, Selena felt more energetic and had even started working out. Her subsequent blood tests showed that her thyroid had stabilized.

When Patrick, 40, was diagnosed with HIV, his immune system was very suppressed. He had a CD4 count of 50, so he started HIV treatment immediately. He responded extremely well to treatment and his CD4 count rapidly increased to 300 within a year. However, 19 months later, he was experiencing new symptoms: He felt hot all the time and was "sweating like a machine." He was irritable and shaky and, despite drinking no coffee, his heart was racing like he was "on a bad caffeine trip." Over the past year he had made great strides to gain weight but more recently had been shedding pounds despite eating all the time. Based on Patrick's description of his symptoms and the results of a blood test, his doctor diagnosed him with a type of overactive thyroid (hyperthyroidism) known as Graves' disease, likely triggered by the strong immune response he had to his HIV treatment. Patrick was prescribed an anti-thyroid medication and another drug to slow his heart rate and decrease the tremor. After a couple of months on these meds, his thyroid levels stabilized and he felt much more like his old self again.


How It Works

The thyroid gland is a small butterfly-shaped gland that sits in the front of the neck, just below the Adam's apple and above the collarbone. It produces the thyroid hormones thyroxine (T4) and tri-iodothyronine (T3), which affect a person's metabolism. They control how our bodies store and use energy and they help regulate our mood and weight.

The release of thyroid hormones into the bloodstream is a complex process, controlled by several glands and hormones in the body. One of these hormones -- thyroid stimulating hormone (or TSH), produced by the pituitary gland, a tiny gland attached to the base of our brains -- regulates the amount of hormones the thyroid releases into the bloodstream.

When a person does not produce enough thyroid hormone and their metabolism slows down as a result, as Selena's did, they are said to have an underactive thyroid, or hypothyroidism. Hypothyroidism can be tricky to recognize because many of the symptoms are not specific to thyroid disease and can be caused by other conditions that people living with HIV may have.

The most common symptoms of hypothyroidism, which generally develop slowly over time, are fatigue, weight gain, dry skin, and hair on the head that is dry, thinning or falls out easily. Other symptoms include feeling cold easily, a slow heart rate, brittle fingernails, a hoarse voice, numbing or tingling of the hands and/or feet (a pins and needles sensation), constipation, a decreased ability to sweat, depression and memory problems. Some people also develop a visibly enlarged thyroid, called a goiter.

On the other end of the spectrum, some people, like Patrick, produce too much thyroid hormone due to an overactive thyroid, or hyperthyroidism. Instead of slowing down as it does with hypothyroidism, the body's metabolism speeds up. Hyperthyroidism is usually associated with an enlarged thyroid and can cause a rapid heart rate, weight loss, tremor, anxiety and increased appetite. Other symptoms include bulging eyes, heat intolerance, warm moist skin, excessive sweating, heart palpitations, muscle weakness and frequent bowel movements.


Medications That Can Affect the Thyroid
MedicationEffect

ritonavir (Norvir, also in Kaletra)

heart drug amiodarone (Cordarone)

hepatitis C drug interferon-alfa (Pegasys, Pegetron)

TB drug rifampin (Rifadin, Rifater)

anti-seizure medications carba-mazepine (Tegretol), phenytoin (Dilantin) and phenobarbital

anti-manic drug lithium (Carbolith)

hyperthyroidism medications* methimizole (Tapazole) and propylthiouracil (Propycil)

hypothyroidism

d4T (stavudine, Zerit)

a mild form of hypothyroidism that causes either very mild symptoms or no symptoms at all

efavirenz (Sustiva, Atripla)

heart drug amiodarone (Cordarone)

hepatitis C drug interferon-alfa (Pegasys, Pegetron)

iodinated contrast dye (sometimes used in imaging tests)

hypothyroidism medication* levothyroxine (Synthroid, Eltroxin)

hyperthyroidism

* When the dose of a medicine used to treat hyperthyroidism is too high, it can lead to hypothyroidism. On the flip side, when the dose of a medicine used to treat hypothyroidism is too high, hyperthyroidism can result.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
An HIVer's Guide to Metabolic Complications
TheBody.com's Lipoatrophy Resource Center
More on Lipodystrophy & Metabolic Complications

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