[Graves' disease in HIV patient receiving antiretroviral therapy].

The article focuses on the clinical case of Graves’ disease in a patient with HIV infection who is receiving antiretroviral therapy. The number of HIV-infected patients has increased significantly in recent decades all over the world. The currently used highly active antiretroviral therapy can significantly improve the prognosis for these patients. However, its use is associated with a number of complications, in particular the development of immune reconstitution syndrome, under which the development of such autoimmune diseases as Graves’ disease, polymyositis and Guillain-Barre syndrome may occur. Therefore, we would like to draw the attention of doctors to the possibility of such a complication in patients receiving antiretroviral therapy. Timely diagnosis and treatment of thyroid disorders will help to avoid the complications associated with an excess or deficit of thyroid hormones.

Levothyroxine replacement therapy in patients with subclinical hypothyroidism and coronary artery disease.

OBJECTIVE: To assess the potential benefits and risks associated with levothyroxine (LT4) therapy in patients with subclinical hypothyroidism (SH) and concomitant coronary artery disease (CAD). METHODS: We enrolled 33 patients (4 male and 29 female subjects) with SH and CAD in this study. The study cohort consisted of 2 groups: 19 patients who were randomly assigned to receive LT4 therapy, titrated to maintain a normal serum thyrotropin level (main group), and 14 patients who did not receive any LT4 replacement therapy (control group). Variables of the lipid profile and left ventricular diastolic function were measured and 24-hour electrocardiographic monitoring was performed before randomization and at 6-month follow-up. Medical therapy for the CAD remained unchanged throughout the 6-month study period. RESULTS: In the main group, no statistically significant differences were found in the lipids, variables of left ventricular diastolic function, and heart rate pattern between the hypothyroid and euthyroid states. Individual analysis revealed, however, that LT4 therapy was beneficial in terms of lipid abnormalities in those patients with lower body mass index, shorter history of CAD, and higher cholesterol levels at baseline. In the control group, we noted statistically significant prolongation of early filling deceleration time after 6 months, which indicated less flexibility of the left ventricular myocardium and diastolic myocardial dysfunction with long-term SH. In reference to adverse effects of LT4 therapy, 5 of the 19 patients had an increased rate of ventricular premature beats. These 5 patients were significantly older and initially had more supraventricular and ventricular premature beats than the rest of the main group. No ST depressions were recorded during LT4 therapy. CONCLUSION: In patients with SH and CAD, LT4 therapy can be beneficial in diminishing lipid abnormalities in those with lower body mass index, briefer duration of CAD, and higher levels of cholesterol at baseline. Patients in our study who experienced adverse effects of LT4 treatment were older and had more supraventricular premature beats at baseline in comparison with the other patients.

TSH and thyroid hormones concentrations in patients with hypothyroidism receiving replacement therapy with L-thyroxine alone or in combination with L-triiodothyronine.

The aim of this study was to evaluate parameters of thyroid function in patients with primary hypothyroidism receiving either monotherapy with L-T4 or combination L-T4+L-T3. Fifty-eight women with primary hypothyroidism receiving L-T4 were enrolled in the study. The patients were randomised into two groups: Group 1 (n=42) patients continued monotherapy with L-T4, and Group 2 (n=16) patients were switched to combined therapy with L-T4+L-T3 (25 microg L-T4 was replaced with 12.5 microg L-T3). The final examination was carried out 6 months thereafter. There was also a third group of 20 healthy women (control group). Under monotherapy with L-T4, serum FT4 levels were higher (p < 0.05) and FT3 lower (p < 0.05) than in the control group, while the monotherapy subgroup of patients with low-normal TSH had serum FT4 levels higher than in the control group (p < 0.05). Serum FT4 under combined therapy was significantly lower than in both control and monotherapy groups. FT3 levels did not differ between the two groups of combined and monotherapy subjects; the highest FT3 levels were in the control group. L-T4 replacement therapy is associated with non-physiologically high FT4 and low FT3 levels. Therapy with L-T3 once a day does not simulate the normal production of T3 by the thyroid.