A journal article on HIV/Aids.Acquired immune deficiency syndrome (AIDS), a disease predictive of a defect in the cell-mediated immunity, is caused by the human immuno-deficiency virus (HIV).1'1 Infection with this virus results in a gradual but progressive deterioration of immune function leading to disease manifestation. The syndrome is characterised by generalised infection and lymphad- enopathy, and is often associated with multisystem disorders.
Patients with AIDS have been reported to have a high frequency of endocrine abnormalities, mostly affecting the adrenal gland, but also the thyroid and other endocrine organs.4-8 These lesions may result from necrosis, infection of the organs, or malignant transformations, presenting as Kaposi sarcoma

Chukwurah, E.

Ezeala, C.C.

Central African Journal of Medicine

English

IDS OpenDocs

■Vol. 40, No. 8 CONTENTS August, 1994
ORIGINAL ARTICLES
Neoplasms involving the spinal cord in 
Zimbabweans: an analysis of 262 cases............
Termination of pregnancy using extra-amniotic 
prostaglandin F2a-  experience in a peripheral 
hospital................................................................ .
Epidemiological study of drug use in urban and 
rural secondary schools in Zimbabwe................
A comparison of three types of “M” traps for 
sampling tsetse fly (Diptera: Glossinidae) popu­
lations at South Luangwa Game Management 
Area, Zambia.......................................... .........
PI Garrido, S Laher-Mooncey, NL Murphree,
N Jonker, LF Levy, S Makarawo..........................201
A Krolikowski, KA Janowski, JV Larsen............ 204
SW Acuda, AH E ide............................................. 207
MM Ziba, M Mukunyandela, S Siziya, JS Chipipa,
L Mwanza...............................................................212
Increased susceptibility of erythrocyte membrane 
lipids to peroxidation in sickle cell disease..........
CASE REPORTS
Intracranial Burkitt’s lymphoma with extension 
into orbital spaces resulting in bilateral blindness
Munchausen syndrome by proxy -  a case report 
and review of literature..........................................
Hypothyroxinemia in Acquired Immune 
Deficiency Syndrome (AIDS)...............................
REVIEW ARTICLES
Advances in electrodiagnosis in Zimbabwe. 
Part II: “Evoked Potentials’
EU Essien.............................................................. 217
K Ramesh, LD Gahukamble, DB Gahukamble ...220
OA Oyelami, AM Alhaj, IK Airede.....................222
CC Ezeala, E Chukwurah..................................... 226
O Parry, LF Levy, J M ielke................................. 229
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CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 40, No. 8, 1994
Hypothyroxinemia in 
Acquired Immune 
Deficiency Syndrome 
(AIDS)
CC EZEALA* *, E CHUKWURAH* * 
SUMMARY
Serum thyroxine (T4) and thyroid stimulating hormone 
(TSH) were studied in 38 patients confirmed to be 
infected with HIV-1 virus and the results compared 
with values observed in age matched healthy subjects. 
The mean serum total T4 in the majority of the patients, 
103 ± 32 nmol/L, was similar to values observed in the
*Radioimmunoassay Unit 
Department of Radiation Medicine 
University o f Nigeria Teaching Hospital 
Enugu, Nigeria
**Spedal Research Laboratory 
Department of Haematology atul Immunology 
University o f Nigeria Teaching Hospital 
Enugu, Nigeria 
Correspondence to:
Christian C Ezeala 
RIA Unit
Department of Radiation Medicine 
UNTHPMB 01129 
Enugu, Nigeria
controls, 102 + 21 nmol/L, p > 0,05. However, 22,2 pc 
of the HIV-1 infected patients had total serum T4 
values that were significantly lower than values in the 
controls, 36 ± 12 nmol/L, p < 0,001.
Since hypothyroxinemia has been associated with 
increased mortality in critical illness, we suggest that 
assessment of thyroid function may be helpful in the 
management of some patients with AIDS.
INTRODUCTION
Acquired immune deficiency syndrome (AIDS), a dis­
ease predictive of a defect in the cell-mediated immu­
nity, is caused by the human immuno-deficiency virus 
(HIV).1'1 Infection with this virus results in a gradual 
but progressive deterioration of immune function lead­
ing to disease manifestation. The syndrome is 
characterised by generalised infection and lymphad- 
enopathy, and is often associated with multisystem 
disorders.
Patients with AIDS have been reported to have a 
high frequency of endocrine abnormalities, mostly 
affecting the adrenal gland, but also the thyroid and 
other endocrine organs.4-8 These lesions may result 
from necrosis, infection of the organs, or malignant 
transformations, presenting as Kaposi sarcomas.4-6
Altered thyroid function in critical non thyroidal 
illness has become well recognised.9-11 Thus, circulat­
ing levels of triodothyronine (T3), thyroxine (T4), and 
thyroid stimulating hormone (TSH), can change re­
markably, with values falling outside expected ranges 
in healthy subjects.
We examined circulating levels of total serum T4 
and TSH in some Nigerian patients known to be in­
fected with HIV-1 and compared these with values in 
normal subjects.
MATERIALS AND METHODS
The patients, 38 in number, comprising 24 males and 
eight females with a mean age of 28 ± 10,3 years (± SD) 
were admitted into the University of Nigeria Teaching 
Hospital for a variety of disease conditions including 
pulmonary tuberculosis, generalised infections, and 
chronic renal failure. They were all screened and con­
firmed to be seropositive for antibodies to HIV-1.
The control consisted of a group of age matched 
apparently healthy subjects drawn from blood donors 
at the University of Nigeria Teaching Hospital Blood
226
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 40, No.8,1994
Bank and hospital staff screened and found to be 
seronegative for antibodies to HIV-1 and 2 and HbS 
Ag.
Five millilitres of venous blood were collected from 
each subject and the sera separated and stored at -20C° 
until required for analysis.
Screening for antibodies to HIV-1 and 2 were done 
using Wellcozyme HIV 1+2 kits (Murex Diagnostics 
Ltd, Dart Ford, England). Confirmatory tests were by 
Western blot using NOVAPATH HIV-1 immunoblot 
(Bio Rad Laboratories Ltd, Hampstead, UK).
Total serum T4 was estimated by an ‘in-house’ 
radioimmunoassay using reagents obtained from 
NETRIA (St Bartholomew’s Hospital, London, UK). 
Radioactive measurement was accomplished with a 
multiwell gamma counter (Oakfield Instruments Ltd, 
Oxon, USA) interphased to an AMSTRAD PC 1640 
Computer and Epson LX — 850 Printer. Interpolation 
and curve plotting were achieved with the aid of these 
instruments using a logit-bog data reduction model.
Serum TSH was estimated using an ‘in-house’ double 
antibody immunoradiometric assay with reagents ob­
tained from NETRIA. Radioactivity measurement and 
interpolation were accomplished with the above instru­
ments on a five parameter logistic model. All assays 
were done in duplicate and results presented as mean ± 
standard deviation (SD).
RESULTS
A mean T4 value of 102 ± 21 ninol/I. was obtained in 
the controls with observed values varying between 57 
and 163 nmol/L, while the mean serum TSH was 3,2 ± 
1,2 mU/L with observed values varying between 0,6 
and 6,8 mU/L. Serum T4 values in 30 of the 38 AIDS 
patients were similar to the values in the controls, 103 
± 32 nmol/L p > 0,05, with observed values varying 
between 56 and 150 nmol/L. Serum TSH in these 
patients were also similar to the controls having a mean 
value of 3,6 ± 1 ,9  mU/L, p > 0,05. However, three 
patients had TSH values below the lower reference 
value. The T4 and TSH values in the controls and the 30 
patients are shown in Table I.
Eight patients (i.e. 22,2 per cent) had total serum T4 
values that were significantly less than values in the 
controls, 36 ± 12 nmol/L, p < 0,001. However, serum 
TSH values were not significantly different from val­
ues in the controls, 3,8 ± 2,5 mU/L, p > 0,005, except 
one patient who had a TSH value of 12,6 mU/L. The T4 
and TSH values in the eigh t patients with 
hypothyroxinemia are shown in Table II.
Table I: Serum T4 and TSH in controls and AIDS 
patients with normal thyroid function.
T4 (nmol/L TSH (mU/L)
Controls 102 ±21 3,2 ± 1 ,2
(5 7 -1 6 3 ) (0 ,6 -6 ,8 )
n = 62 n = 35
AIDS patients 103 ±32 3,6 ± 1 ,9
(5 6 -1 5 0 ) (< 0 ,6 -7 ,1 )
n = 30 n = 30
Results are presented as mean ±  SD. 
Values in brackets represent the range.
Table II: Serum T4 and TSH in the eight patients
with hypothyroxinemia.
S/no T4 (nmol/L TSH (mU/L)
1 40 2,8
2 25 12,6*
3 25 4,4
4 50 1,0
5 50 7,4
6 45 7,1
7 16 3,2
8 40 1,0
Range 1 6 -5 0 1 ,0 -1 2 ,6
Mean 3 6 ± 1 2 3,8 ± 2 ,5
"This value is an outlier; it is not included in the calculation 
of mean value.
DISCUSSION
Our study reveals that the majority of patients infected 
with HIV-1 had normal thyroid function. However, a 
significant number had hypothyroxinemia. There are 
many possible causes of hypothyroxinemia in critical 
illness. A decrease in serum thyroid hormone binding 
globulin (TBG) level12 and inhibition of T4 binding to 
TBG due to the presence of an inhibitor sometimes 
found in the plasma of critically ill patients13, may be 
responsible for the low T4 values observed in some of 
these patients.
227
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vo], 40, No. 8, 1994
Measurement of the physiologically active free hor­
mone in the form of free thyroxine index (FTI) or 
routine free T4 (FT4) assays by some workers1415 has 
revealed a high incidence of low values in intercurrent 
non thyroidal illness. The conclusion, therefore, has 
been that using these parameters as estimates of thyroid 
activity may be misleading in a high proportion of 
patients.16 '7 Nevertheless, hypothyroxinemia has been 
associated with high mortality and poor prognosis in 
critically ill patients.1418 We, therefore, suggest that 
thyroid assessment may be helpful in the management 
of some patients sick with AIDS and AIDS associated 
conditions.
The secretion of TSH has been reported to be inhib­
ited in severe non thyroidal illness.19 This may account 
for the low values found in some of our patients. 
Although pituitary insufficiency has been reported in 
AIDS,20 Verges and others observed that this is likely 
to be infrequent.21
ACKNOWLEDGEMENTS
We are grateful to Mrs E Udekwu for typing the manu­
script.
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Hypothyroxinemia in Acquired Immune Deficiency Syndrome (AIDS)

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Hypothyroxinemia in Acquired Immune Deficiency Syndrome (AIDS)

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