Spectrum of Thyroid Abnormalities among Children Living with HIV in Lagos, Nigeria

Abstract

Thyroid disorders have been described in an adult population but are underreported in the pediatric population. The aim of this study was to determine the prevalence and describe the spectrum of thyroid abnormalities among HIV infected children on Highly Active Antiretroviral Therapy (HAART) in Lagos, Nigeria. This was a cross-sectional study carried out at a teaching hospital with an antiretroviral therapy (ART) center. Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) were analyzed in 83 children living with HIV on HAART and 51 controls. The prevalence of thyroid dysfunction and correlation of fT3, fT4, and TSH with duration on HAART, age, CD4 count, and nutritional status were assessed. Thyroid abnormalities were seen in 9.6% of the children living with HIV comprising subclinical hypothyroidism in 6%, euthyroid sick syndrome in 2.4%, and overt hypothyroidism in 1.2% as compared to 2% subclinical thyroid disease among the controls (p= 0.15). Hypothyroidism was correlated with CD4 count and viral load. None of the patients had clinical features of thyroid disease. Thyroid abnormalities were more prevalent among children living with HIV and yearly screening with follow-up is advocated.

Clinicopathological features of papillary thyroid carcinoma in HIV-infected patients

“…But further studies are needed here (43, 44) (8); Direct cytopathic effects of HIV on the thyroid gland. Here we could put forward such hypotheses: HIV can affect the normal physiological status of the thyroid gland by altering CD4 and CD8 (45,46), or HIV affects thyroid hormone metabolism through the interaction with peripheral T3 receptors, and then affects the status of thyroid follicular cells (47).…”

Thyroid Diseases and Thyroid Asymptomatic Dysfunction in People Living With HIV

“…Subclinical hypothyroidism is the most common thyroid abnormality in both the general population and PLWH, with a large prevalence seronegative elderly women [ 14 , 25 ] and in the pediatric seropositive population [ 36 ]. It is more common in PLWH on ART and with lower CD4 count [ 32 , 37 ].…”

“…The pathogenic features of subclinical hypothyroidism are still not completely understood; however, TBG seems to be implicated in some forms as well as higher TSH levels are associated with a more progressive disease [ 36 ]. It seems that in the case of severe immunocompromisation, the thyroid response and functions are impaired by an increase in the concentration of TBG [ 36 ].…”

“…Overt hypothyroidism is quite rare in PLWH and even more so in children living with HIV (CLWH) [ 36 ]. The manifestations are the same than in the general population, characterized by an insidious and progressive symptomatological cortege of fatigue, weakness, dry skin, cold intolerance, mental slowdown, constipation, hoarse voice, paresthesia, bradycardia and delayed relaxation of tendon reflexes [ 40 ].…”

“… Differences between subclinical and overt hypothyroidism. ↑ elevated; ↓ low [ 36 , 37 , 38 , 39 , 40 ]. …”