Should Thyroid Patients Get the COVID Vaccine?

Average Reading Time: 6 minutes

One question that’s frequently coming up with thyroid patients — and frankly, people across the country — is whether to get a vaccine for COVID-19.

To get a sense of how the patient community views the issue, I conducted an informal online poll in mid-January of 2021, with responses from almost 900 thyroid patients. The main goal was to find out what percentage of patients were planning to get a COVID vaccine when it’s available, and, if not, their reasons. About half the patients surveyed had Hashimoto’s, and most of the respondents were hypothyroid.

The results?

• Almost 56% of respondents said yes, they’ll get the vaccine.
• Almost 25% of respondents said no.
•  About 13% of respondents said they are unsure about whether they’re getting the vaccine.
• And the remaining 6% said that they will get the vaccination, but are waiting until later.

Whether they’ve decided to get the vaccine or not, patients are also concerned that the vaccine is too new, hasn’t been tested with autoimmune patients, may have significant side effects, or may not work as promised. Are the concerns warranted? Let’s take a look at what we know right now.

About the COVID Vaccines

While there are several vaccines still in clinical trials, two have received “Emergency Use Authorization” (EUA) for use in the United States and are currently being administered. The Pfizer and Moderna vaccines are the two currently available COVID vaccines being administered during the initial vaccine rollout in the U.S. 

Both vaccines are mRNA vaccines, a new type of vaccine. An mRNA vaccine basically teaches cells how to make a particular protein element, which then triggers an immune response in the body. As a result, antibodies are produced that can help prevent you from getting infected if/when you are exposed to the real COVID virus later.

Effectiveness: In the trials that have been conducted, these two vaccines have been shown to be around 95% effective at preventing laboratory-confirmed COVID-19 illness in people without evidence of previous infection.

Administration: Both vaccines are given as two shots, into the muscle of the upper arm. The Pfizer shots are given 21 days apart, and the Moderna vaccine’s two shots are given 28 days apart.

Immunity: According to experts, you will start to have some immunity seven days after your first dose. Your immunity will continue to build and will reach a peak about two weeks after the second dose.

Side Effects: Both vaccines have similar side effects.

• After each injection, you can expect mild to moderate pain, soreness, redness and swelling at the injection site.
• You may also experience fever, fatigue, headache, and chills. A small percentage of recipients have also reported nausea, vomiting or diarrhea. These symptoms are more common after the second dose of vaccine.

If you do receive the vaccine, many experts advise that you not try to treat any post-vaccine symptoms or side effects. Rather, you should let your body experience the fatigue, or low-grade fever, etc. This is the immune system responding appropriately, and developing an immune reaction to protect you.

Ingredients: Neither vaccine contains common allergens like eggs, preservatives, or latex. There are, however, a few differences between the ingredients of the two vaccines.

The Pfizer Vaccine

Contains messenger ribonucleic acid (mRNA), lipids (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol), potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dihydrate, and sucrose.

The Moderna Vaccine

Contains messenger ribonucleic acid (mRNA) lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate, and sucrose.

Safety When Getting the Vaccine

The Centers for Disease Control (CDC) is recommending that patients who have had mild allergic reactions to vaccines in the past should be monitored for 30 minutes after getting the vaccine, according to Food and Drug Administration (FDA) guidance. For people without allergies, the recommendation is a 15-minute observation time.

Who Should Not Get the Vaccine?

The COVID vaccines are currently not approved for anyone under 16. It’s anticipated that testing in teenagers and children will take place in 2021 so that the vaccination can be authorized.

According to the CDC, some people should NOT get the mRNA COVID vaccines, including:

• People with a history of having a severe or anaphylactic allergic reaction to any vaccine
• People who have allergic reactions to the components of the new COVID vaccines, in particular, polyethylene glycol (PEG) or polysorbate

Note: having a history of allergies, such as mold, hay fever, pollen, or foods, are not considered a risk for allergic reaction to the COVID vaccines.

Immunocompromised Patients: A Grey Area

People who are immunocompromised fall into a grey area in terms of the COVID vaccines.

Typically, people are considered immunocompromised when they have diseases that cause immunodeficiency (like HIV), are undergoing chemotherapy treatment, or are being treated for certain systemic autoimmune diseases (such as multiple sclerosis or lupus).

There are some considerations. On one hand, people who are immunocompromised might be at increased risk for severe COVID-19. On the other hand, they should be aware that there’s limited safety data about the safety of the current COVID-19 vaccines.

While some HIV patients were included in the vaccine trials, the trials excluded patients with “confirmed or suspected immunosuppressive or immunodeficient states,” — mainly cancer patients getting chemotherapy or radiation, and autoimmune patients taking disease-modifying antirheumatic drugs (DMARDs) and biologic drugs. 

This is because these vaccines may work less effectively in patients on immunosuppressive drugs, and the trials needed to focus on how the vaccines work in healthy adults before they can be studied in specific groups. (Note: This is common for all vaccines, and specific trials in these groups are likely to be published after the vaccines are in more widespread use.)

So, according to the CDC, the decision about whether people who are immunocompromised should get the COVID vaccine is one each individual needs to make with his or her healthcare provider.

An important note: Because autoimmunity involves an immune system dysfunction, some Hashimoto’s and Graves’ disease patients wonder if they’re “immunocompromised.” According to the American Thyroid Association, “Having autoimmune thyroid disease does not mean that a person is immunocompromised.”

UP NEXT: THE CORONAVIRUS SURVIVAL GUIDE FOR THYROID PATIENTS

What About Thyroid and Autoimmune Disease Patients?

Patients with thyroid conditions and various autoimmune diseases (including patients with Hashimoto’s thyroiditis and Graves’ disease) were included in the vaccine trials. While there were few adverse effects in the trials, researchers have not yet broken out data on adverse effects in patients with thyroid conditions or autoimmune thyroid disease to date.

As noted before, people suffering from systemic autoimmune conditions that require immunosuppressive medications were excluded from the vaccine trials.

In general, live vaccines — like measles/mumps/ rubella (MMR) vaccine, and the FluMist nasal flu vaccine — are typically not recommended for autoimmune patients. The Pfizer and Moderna COVID-19 vaccines (along with those in development from AstraZeneca and Johnson & Johnson) are not live vaccines, however. The main concern is that they may not be as effective at protecting against COVID-19 in autoimmune patients. 

There is also some concern that susceptible patients with autoimmune disease may have a flare triggered by a vaccine. There are anecdotal reports of autoimmune flares post-vaccines in general, but no direct studies have shown a clear connection. Experts tend to agree, however, that the risk of a potentially deadly virus like COVID-19 outweighs the risk of a flare, especially when flares can be safely treated.

Note that doctors do recommend that you not get the vaccination when you are in an active autoimmune flare, and wait until your immune system has calmed down.

In an article by Mo Perry at Medium, vaccine expert Gregory Poland, MD of Mayo Clinic’s Vaccine Research Group is quoted as saying, “I’d say someone with an autoimmune disease would be at much higher risk from complications of being infected with COVID-19…Until we have data to the contrary, for the majority of people with autoimmune disease, their risk of complication from infection is far higher than the observed teeny risk attributable to any of the COVID vaccines.”

What If You Already Had COVID?

Getting COVID-19 may offer some immunity against being infected again. Current evidence suggests that reinfection with the virus that causes COVID-19 is not common, especially in the three to five months after the initial infection. This is not definitive, however, and experts don’t know how long immunity lasts. 

Many experts are recommending that patients consider getting the vaccine even if they’ve already been infected with COVID, because the risk of severe illness and death from COVID-19 outweighs any benefits of an uncertain period of natural immunity.

After the Vaccine

Even after you’ve gotten a vaccine, the experts are still recommending that you follow all the safety protocols related to COVID-19, including:

• Wearing a mask
• Staying at least six feet away from others
• Avoiding crowds
• Hand hygiene
• Following quarantine guidance after exposure to COVID-19

This is particularly applicable if you have an autoimmune disease, as we still don’t know if autoimmunity reduces the effectiveness of the COVID vaccine.

Weighing Your Decision

Here’s what we know. The experience of COVID-19 is wide-ranging. Some people have no symptoms at all, or a few days of mild, cold- or flu-like symptoms like congestion, sore throat, runny nose, low-grade fever, and fatigue, and recover quickly. Others have many weeks of debilitating symptoms, including:

• High fever and chills
• Severe cough
• Shortness of breath, difficulty breathing, fluctuating oxygen levels
• Extreme fatigue and weakness
• Muscle and body aches
• Loss of taste or smell
• Nausea or vomiting
• Diarrhea
• Persistent pain or pressure in the chest
• Confusion and brain fog

After COVID infections, some patients seem to never fully recover, and develop a longer-term post-viral syndrome that some are calling “Long Haul COVID.” Chronic symptoms can include severe exhaustion, breathlessness, reduced oxygen levels, chest pain, and, in some cases, permanent damage to the heart, lungs, vascular system, and other organs.

And, unfortunately, as we know, the most severe COVID-19 cases can require hospitalization, with supplemental oxygen or intubation. Patients with severe COVID-19 can develop blood clots, go into respiratory failure, or develop heart, lung, and other organ failure, and in a small percentage of hospitalized patients, these complications are fatal.

There’s no definitive way to predict your course if you are infected with COVID-19. We know that advanced age, obesity, type 2 diabetes, and some other pre-existing conditions are major risk factors for complications. But young, healthy, fit athletes have died from COVID. Healthy adults of all ages have weathered symptomatic COVID at home, and then developed debilitating “Long Haul COVID” that has lasted for months. Patients of all ages with multiple pre-existing conditions have survived it fairly unscathed. It’s the utter unpredictability of the course of the virus that is so perplexing for doctors and patients.

Meanwhile, as COVID-19 is still very much with us in the U.S., we are also dealing with the arrival and inevitable spread of the more infectious strain of the virus that has already hit Europe. Some experts estimate the new strain is at least 50% MORE infectious than the current strain. That means that we’ll be dealing with an even higher risk of infection in 2021.

In the end, you’ll need to weigh your risk of contracting COVID-19 — and the potential that you could develop a severe case of COVID, or “Long Haul COVID” — versus whatever potential risks are associated with the vaccine. 

At present, there’s no established scientific data showing that thyroid patients (even those with autoimmune disease) are at any extra risk from the COVID vaccines. But ultimately, the decision to get a COVID-19 vaccine is yours to make, in consultation with your healthcare provider.