Thyroid UK has received enquiries about whether people with thyroid disease are at an increased risk of coronavirus (COVID-19). After consulting our medical advisers we have prepared the following statement:
COVID-19 is a new virus that can affect your lungs and airways and cause various symptoms, the most common of which is a cough, a high temperature (fever) and difficulty in breathing.
In people with weakened immune systems, older people, and those with long-term conditions like asthma, diabetes, cancer, heart disease and chronic lung disease the symptoms can be much worse. However, these symptoms are similar to other viruses such as a cold and the flu so having these symptoms does not necessarily mean you have the illness. You can only know that if you test for it and we know that is difficult to do at the moment. There are plans now, though, to send out testing to random members of the public and more testing will be available in the future.
Doctors are not completely sure how the virus is spread but it is probably spread by droplets produced when an infected person coughs or sneezes and may be caught by touching a surface, object or the hand of an infected person. How long any respiratory virus survives will depend on a number of factors such as what surface the virus is on; whether it is exposed to sunlight; differences in temperature and humidity and exposure to cleaning products.
COVID-19 can be spread by close contact (within 2 metres or less). It is not definite whether people with the virus who don’t have symptoms can infect someone else. The incubation period is between 2 to 14 days so if a person remains well 14 days after contact with someone who has the coronavirus, they have not been infected.
Are patients with thyroid disease at more risk?
At the moment, there is no evidence that people with thyroid disease are at any more risk than people without thyroid disease.
A retrospective study by Maaike van Gerwen et al has shown that hypothyroidism was not associated with increased risk of hospitalisation, ventilation or death.
However, it is possible that untreated hypothyroidism, undertreated hypothyroidism (because the medication is not being taken or not taken properly) or poorly controlled hyperthyroidism may be at higher risk of complications from the virus.
It will pay to be vigilant. Wash your hands regularly and, as the Government has now advised, work at home if you can, don’t travel on public transport unless it is necessary and use face masks when you go anywhere where there are a lot of people.
Hashimoto’s disease and Grave’s disease are autoimmune disorders that directly affect the thyroid i.e. the antibodies affect how the thyroid works. Thyroid disease autoimmunity does not mean that you have a depressed immune system. It means that your immune system is attacking your thyroid. These are two different things.
Thyroid medications do not weaken your immune system. Only immunosuppressants do this and those that are on immunosuppressants need to be extra vigilant and be shielded.
Also, anyone on high doses of steroids, such as those with thyroid eye disease, may be compromised because steroids can suppress the immune system. Again, be vigilant if you are on steroids.
If you have thyroid cancer, you should definitely take the Governments advice and be shielded although shielded people can now start to go outside.
The British Thyroid Association have published some excellent information which we recommend you read:
“The COVID-19 pandemic presents significant challenges to us all. The following statements regarding the management of thyroid disease have been formulated to provide clinical advice to medical colleagues during this time:
- BTA/SFE advice regarding resource-limited treatment of thyrotoxicosis during the COVID-19 pandemic
- Advice for patients with thyroid cancer (Statement by Thyroid Cancer Forum UK, SfE and BTA)
We hope you find them useful.”
Thyroid UK also recommends that everyone follows NHS and government advice about reducing the risk of infection which you can find here:
Can COVID-19 cause thyroid disease?
There does seem to be a link between COVID-19 and thyroid disease.
There has been a paper published in The Journal of Clinical Endocrinology & Metabolism regarding the case of an 18-year-old woman who contracted COVID-19 and recovered but a few days later was diagnosed with subacute thyroiditis. There has also been a possible case in Texas.
The latest study comes from Italy and is entitled, “Thyrotoxicosis in Patients with Covid-19: The Thyrcov Study.”
It looked at 297 consecutive patients in non-intensive care units who were not on treatment for hypothyroidism or hyperthyroidism. Fifty-eight patients (20.2%) were found with thyrotoxicosis (overt in 31 cases), 15 (5.2%) with hypothyroidism (overt in only 2 cases) and 214 (74.6%) with normal thyroid function.
The researchers concluded, “This study provides a first evidence that COVID-19 may be associated with a high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection.”
So it seems that once you have had COVID-19, you need to be aware that it may affect your thyroid. Our advisers will be keeping us up to date periodically and we will be updating this statement when necessary. Stay safe everyone!