Position statement on COVID-19

Updated: v1.14 (12th November 2021)

We’ve added the booster poll.

Thyroid UK is thankful to all front-line workers who are still looking after people with Covid.  We hope that this winter will not  be as bad as last winter and that next year will bring better news about how Covid is affecting us all.

Thyroid UK has received enquiries about whether people with thyroid disease are at an increased risk of coronavirus (COVID-19).

We have checked with our medical advisers and have the following statement to make:

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 this is easier to do than it was last year.

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. 

Our partner Blue Horizon now offers Private COVID-19 Tests with a special discount via Thyroid UK.

Are patients with thyroid disease at more risk?

The evidence out there seems to be contradictory.  There is some evidence that people with thyroid disease have an enhanced risk of severe Covid-19 infection – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387272/

However, a retrospective study in 2020 has shown that hypothyroidism was not associated with increased risk of hospitalisation, ventilation or death – https://www.frontiersin.org/articles/10.3389/fendo.2020.00565/full   

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 you need to decide whether or not it is better to wear masks in public places.

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:

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 although, again, there is contradictory research.

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 .  The author has alerted clinicians about this case – https://academic.oup.com/jcem/article/105/7/dgaa276/5838793

There has also been a possible case in Texas – https://www.nbcdfw.com/news/coronavirus/covid-patient-develops-new-symptoms-months-later-likely-tied-to-virus/2403180/

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 high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection.” –https://eje.bioscientifica.com/view/journals/eje/aop/eje-20-0335/eje-20-0335.xml

There has also been reports of people who have had severe COVID-19 going on to become ill with a relapse of Graves’ disease or newly diagnosed Graves’ disease about a month after the virus infection:

https://www.healio.com/news/endocrinology/20210519/covid19-may-trigger-graves-disease-relapse-subacute-thyroiditis

https://casereports.bmj.com/content/bmjcr/14/8/e244714.full.pdf

Researchers looked at the thyroid function tests (TFTs) of 144 COVID-19 patients who were admitted to a single care intensive care units because previous reports had shown that there were alterations in TFTs with associations to either a destructive thyroiditis or non-thyroidal illness. Patients with known thyroid disease were excluded.

“The majority of patients they looked at had normal TSH on admission, usually with normal FT4 and FT3.  Low TSH levels were found either at admission or during hospitalization in 39% of patients, associated with low FT3 in half of the cases. FT4 and Tg levels were normal, and TgAb-negative. TSH and FT3 were invariably restored at the time of discharge in survivors, whereas were permanently low in most deceased cases, but only FT3 levels were predictors of mortality. Cortisol , CRP and IL-6 levels were higher in patients with low TSH and FT3 levels.”

The researchers concluded that, “Almost half of our COVID-19 patients without interfering drugs had normal TFTs both at admission and during follow-up. In this series, the transient finding of low TSH with normal FT4 and low FT3 levels, inversely correlated with CRP, cortisol and IL-6 and associated with normal Tg levels, is likely due to the cytokine storm induced by SARS-Cov-2 with a direct or mediated impact on TSH secretion and deiodinase activity, and likely not to a destructive thyroiditis.”

Another study looked into serum thyroid hormone (TH) levels in adult COVID-19 patients, admitted between June and August 2020 to determine whether they reflect the severity or mortality associated with the COVID-19 – https://www.liebertpub.com/doi/epdf/10.1089/thy.2021.0225

Severe illness, we know, already causes non-thyroidal illness syndrome (NTIS) and one of the goals of this study was to study the predictive value of NTIS and serum TH levels on disease severity and patient mortality.

The study reported data on the largest number of hospitalized moderate-to-severeCOVID-19 patients and correlated serum TH levels with illness severity, mortality, and other biomarkers to critical illness.

The conclusion was that, “The data revealed the importance of early assessment of thyroid function in hospitalized patients with COVID-19, given the good prognostic value of serum fT3, rT3, and fT3·rT3 product. Further studies are necessary to confirm these observations.”

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

Read our new article on Vitamin D and COVID-19.

COVID-19 Vaccine

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.” ​1​

Therefore having an autoimmune condition does not mean you are on the vulnerable list for the COVID-19 vaccine.

The vaccine is NOT obligatory although, of course, it would be safer for you and everyone else around you to have it.

There has been a reports cases where people have received a Covid vaccine and developed clinical manifestations of Graves’ disease (with increased thyroid hormone levels, suppressed TSH and elevated antithyroid antibodies) three days later: https://pubmed.ncbi.nlm.nih.gov/33858208/

As soon as any research is published on this topic, we will be informing people via our membership and our social media. If you haven’t already, you could take a look at the polls on our online community and our Facebook page to see what people who have thyroid disease are saying about having the vaccine:

https://healthunlocked.com/thyroiduk/posts/145277107/thyroid-disorder-and-covid-19-vaccination-what-was-your-experience

https://www.facebook.com/thyroiduk/posts/3927830333948167

https://healthunlocked.com/thyroiduk/polls/147048266/thyroid-disorder-and-covid-19-booster-vaccination.-this-poll-is-not-for-the-third-vaccination-for-immunosupressed-people

Stay safe everyone!

Date updated: 12.11.21 (V1.14)
Review date: 25.10.23

References

  1. 1.
    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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