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4th COVID-19 Shot: Should Hashimoto's Patients Get One?

Learn what experts say about who may need a second COVID-19 booster and who may not.
4th COVID-19 Shot: Should Hashimoto's Patients Get One?
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COVID-19 vaccines are effective in preventing severe COVID-19 infection. Still, recent data suggest their effectiveness in preventing severe illness decreases over time, especially in people over 65 years old.


The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 12 should get a COVID-19 vaccine booster. Additionally, the Food and Drug Administration (FDA) says that people over 50 can also get a second booster dose of the Pfizer-BioNTech or the Moderna COVID-19 vaccination. The FDA also recommends that some immunocompromised people over the age of 12 get a second booster dose four months after their first booster.

According to the National Institutes of health, mixing vaccines may enhance immune response. Mixing vaccines also increases scheduling flexibility when one particular vaccine is not readily available. 

Ahead, a look at whether people with Hashimoto's disease require a fourth COVID-19 vaccine.

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How long are COVID-19 booster shots effective for?

In February of 2022, a study by the CDC revealed that the effectiveness of Pfizer and Moderna's booster shots significantly declined after four months during the Omicron surge. The study suggests that there may be a need for an additional COVID-19 vaccine dose in the future. 


Researchers are still learning about the protection period that booster doses provide against variants. For instance, vaccine effectiveness against the Omicron variant depends on the type of vaccine, the number of doses given, the vulnerability of the recipient, and the time since vaccination. It is known that boosters provide significant protection against severe illness. 


Viruses are constantly evolving; they can mutate every time a person gets sick and passes those germs to another person. The CDC keeps track of COVID-19 variants that emerge in the United States and worldwide. Variants are expected to keep showing up as long as COVID-19 exists. Still, viruses cannot change and evolve as much when we take the proper action.


Future variants can be stopped from forming as more and more people get vaccinated. The CDC considers you optimally protected when completing all your recommended booster shots.


Research shows that hospitalization and death rates were much lower during the Omicron wave for people who are up to date in their vaccinations versus those who are unvaccinated.


Immunocompromised patients should receive a fourth COVID shot

Those with compromised immune systems are at greater risk of severe COVID-19 and death. The CDC recommends an additional shot or a fourth shot for these immunocompromised people. About seven million American adults are considered immunocompromised, including people who have certain medical conditions that impair their immune response or take immune-suppressing drugs due to organ transplants, cancer, or some autoimmune diseases. 


Are Hashimoto's patients immunocompromised?

Immunodeficiency is when the immune system doesn't respond appropriately to infection. Autoimmunity is when the immune system is overactive and responds to healthy cells as though they were foreign.

Hashimoto's thyroiditis is an autoimmune disease. Hashimoto's occurs when your body makes antibodies that mistakenly attack the cells in your thyroid, eventually causing the thyroid to not be able to make enough of thyroid hormones. Hashimoto's disease is the leading cause of hypothyroidism (an underactive thyroid gland) in the United States. People with hypothyroidism need to take thyroid hormone replacement medication to keep their thyroid hormone levels normal.


Having an autoimmune thyroid disease does not make you immunocompromised. However, sometimes people with one autoimmune disease develop a second or third autoimmune disease, and this is called polyautoimmunity. If you have Hashimoto's disease, you may be at higher risk of developing another autoimmune condition that does cause immunodeficiencies like lupus or myasthenia gravis.


Additionally, some autoimmune conditions like psoriasis, lupus, rheumatoid arthritis, Crohn's disease, multiple sclerosis, and alopecia areata require treatment with immunosuppressant drugs. Immunosuppressants suppress the immune system to reduce the autoimmune reaction, possibly causing immunodeficiency.


Should Hashimoto's patients get a fourth COVID booster shot

After five months of the final date of your two-dose mRNA primary vaccine series, people over the age of 12, who are not immunocompromised, should get a booster dose. Currently, there is no evidence that a second booster dose is needed in this population, including adults diagnosed with Hashimoto's disease who are not otherwise immunocompromised. 

The Food and Drug Administration (FDA) says that people over 50 can also get a second booster dose of the Pfizer-BioNTech or the Moderna COVID-19 vaccination. Although Hashimoto's disease may occur in teens or young women, it more often develops in women ages 30 to 50. So if you have Hashimoto's disease and are over the age of 50, you may want to get a second booster dose of the COVID-19 vaccine.


In the future, recommendations may change regarding who requires a second booster dose. A study preprint found that rates of severe illness from a COVID-19 infection were lower after a fourth vaccine dose. However, early results of two clinical trials also found that while a second booster dose boosts antibodies, it still may not prevent people from getting COVID-19. More studies are needed to evaluate whether second booster doses are necessary.


A note from Paloma Health

We recommend that you talk with your health care provider about a second booster dose because they know your complete medical history and understand your overall risk. The information in this article is current as of April 14, 2022, which means newer information may be available when you read this. For the most recent updates on COVID-19, please visit the Centers for Disease Control and Prevention website.

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Katie Wilkinson

Katie Wilkinson, previously serving as the Head of Content and Community at Paloma Health, fervently explores the nexus between healthcare and technology. Living with an autoimmune condition, she's experienced firsthand the limitations of conventional healthcare. This fuels both her personal and professional commitment to enhancing patient accessibility to superior care.

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