To improve the understanding, early diagnosis of Graves’ disease associated with immune reconstitution inflammatory syndrome after highly active antiretroviral therapy (HAART) in patients with acquired immunodeficiency syndrome (AIDS).

Total of 5 cases of Graves’ disease associated with immune reconstitution inflammatory syndrome after HAART admitted to Beijing Ditan Hospital, Capital Medical University from January 2009 to April 2019 were enrolled, the clinical data and diagnosis and treatment methods were analyzed, retrospectively.

The age of 5 cases at diagnosis of Graves’ disease was 19-56 years old (with the average age 35 years old). Four of them were male. The median time from onset of HAART to onset of Graves’ disease symptoms was 22 months. The median CD4⁺ T cell counts in peripheral blood before HAART and at the time of diagnosis of Graves’ disease were 2 cells/μl and 359 cells/μl, respectively. When diagnosis as Graves’ disease, all patients achieved complete inhibition of plasma human immunodeficiency virus (HIV). Similar to common Graves’ disease of patients with HIV negative, the most common symptoms were palpitations and fatigue. One case was complicated with Graves’ ophthalmopathy, while one with hyperthyroidic periodic paralysis and ventricular tachycardia. All five cases were treated with methimazole (MMI), among which 4 cases were cured and 1 cases relapsed, who was cured by iodine-131.

Graves’ disease is one of the manifestations of immune reconstitution inflammatory syndrome in patients with AIDS after HAART. It is relatively late onset and occurs after rapid recovery of immune function in patients with advanced immunosuppression. The possibility of Graves’ disease should be considered in patients with AIDS who develop euthyroid toxicity symptoms such as fatigue that do not match the recovery of immune function.