Updated: v1.10 (3rd March 2021)
We’ve added a link to a new article on vitamin D and COVID-19
Our thoughts are with you all in these difficult times. We understand how worrying it is to not see your family and friends and not know how the coronavirus (COVID-19) would affect you if you catch it. Thyroid UK is thankful to all front-line workers who are looking after us in a variety of ways but especially the NHS and carers who are in the midst of this awful disease.
We have been asked 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 you could be infectious within this timeframe if you have been in contact with someone who had Covid, whether you have symptoms or not. Don’t forget, you can have Covid without symptoms.
Symptoms typically appear within four or five days after exposure. After 14 days of being in contact with someone who has Covid and you have no symptoms, you will not be infectious.
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. 1
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 them 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.
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. We hope you find them useful.”
- 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)
Thyroid UK also recommends that everyone follows NHS and Government advice about reducing the risk of infection:
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.2 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.”3 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.
Vitamin D and COVID-19
We are receiving a lot of queries from people who have thyroid autoimmune disease and who have been offered the COVID-19 vaccination.
At present there is no research on people with autoimmune diseases and the COVID-19 vaccine. It is known that some people will have some minor side effects but not everyone.
Having an autoimmune condition i.e. Hashimoto’s/Graves’ disease , is where antibodies attack a particular part of the body. Being immunocompromised means,
“Having a weakened immune system. People who are immunocompromised have a reduced ability to fight infections and other diseases. This may be caused by certain diseases or conditions, such as AIDS, cancer, diabetes, malnutrition, and certain genetic disorders. It may also be caused by certain medicines or treatments, such as anticancer drugs, radiation therapy, and stem cell or organ transplant. Also called immunosuppressed.” 4
Therefore having an autoimmune condition does not mean you are on the vulnerable list for the COVID-19 vaccine.
However, there has been recent new advice issued on those who should be shielding. This new advice covers topics such as ethnicity, deprivation (by postcode) and being overweight. You should receive a letter inviting you to have the COVID-19 vaccination if your doctor believes you to be in this cohort: https://www.bbc.co.uk/news/health-56086965
The vaccine is NOT obligatory although, of course, it would be safer for you and everyone else around you to have it.
As soon as any research is published on this topic, we will inform you via our website and social media. If you haven’t already, take a look at our poll and our Facebook page to see what people who have thyroid disease are saying about having the vaccine:
Stay safe everyone!
- 1.van Gerwen M, Alsen M, Little C, et al. Outcomes of Patients With Hypothyroidism and COVID-19: A Retrospective Cohort Study. Front Endocrinol. Published online August 18, 2020. doi:10.3389/fendo.2020.00565
- 2.Brancatella A, Ricci D, Viola N, Sgrò D, Santini F, Latrofa F. Subacute Thyroiditis After Sars-COV-2 Infection. The Journal of Clinical Endocrinology & Metabolism. Published online May 21, 2020:2367-2370. doi: 10.1210/clinem/dgaa276
- 3.Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G. Thyrotoxicosis in patients with COVID-19: the THYRCOV study. European Journal of Endocrinology. Published online October 2020:381-387. doi:10.1530/eje-20-0335
- 4.National Institutes for Health (NIH). Definition of immunocompromised. National Cancer Institute. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunocompromised
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