Chronic hepatitis C virus (HCV) infection causes progressive liver fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. It is also involved in the pathogenesis of many extrahepatic diseases manifesting as various autoimmune and rheumatic disorders (arthritis, vasculitis, sicca syndrome, porphyria cutanea tarda, lichen planus, nephropathies, thyroid diseases, metabolic disorders, and lung fibrosis; development of B-cell lymphoproliferative diseases. In this review we look at the endocrine extrahepatic manifestations including thyroid disorders and metabolic disorders (insulin resistance and diabetes mellitus) associated with chronic HCV infection. The existence and severity of extrahepatic manifestations do not correlate with the severity of liver disease, and the mainstay of treatment is HCV eradication. Patients with systemic manifestations of HCV infection should be prioritized for treatment, especially in the era of new interferon-free therapies with fewer side effect.