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COVID-19 Vaccination, Hypothyroidism, and Hashimoto's

Learn about COVID-19 vaccination and how it applies to hypothyroid and Hashimoto's patients.
COVID-19 Vaccination, Hypothyroidism, and Hashimoto's
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Article updated March 22, 2021

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Coronavirus disease (COVID-19) is a highly infectious disease caused by a coronavirus, SARS-CoV-2, that has caused a global pandemic. The U.S. Food and Drug Administration (FDA) granted Emergency Use Authorization to two vaccines for COVID-19—the Pfizer-BioNTech COVID-19 vaccine on and the Moderna COVID-19 vaccine in December of 2020. Ahead, what to know about these vaccines if you have hypothyroidism or Hashimoto's disease

Vaccine development process

There are several stages in the drug development process. Stage 1 is discovery and development, meaning that research for a new drug begins in the laboratory. Stage 2 is preclinical research. This second stage is the step in which medicines undergo laboratory testing to answer basic safety questions. Stage 3 is clinical research, meaning drugs are tested on people to ensure they are safe and effective. In stage 4, the FDA examines all of the submitted data related to the drug or device and decide to approve or not to approve it. Finally, in the fifth, post-market safety monitoring stage in the FDA monitors all drug and device safety once products are available for use by the public.

The Pfizer vaccine gained authorization based on data from an ongoing phase 1/2/3 trial. This trial includes approximately 44,000 participants who are randomized to receive either the Pfizer vaccine or a saline placebo.

The Moderna vaccine gained authorization based on an ongoing phase 3 trial. This trial includes approximately 30,000 participants who are randomized to receive the Moderna vaccine or a saline placebo.

Both vaccines' authorization has been extremely fast, relative to typical FDA approvals. This speedy authorization leaves many of us with questions about the vaccines and who should get the vaccination. The FDA has provided guidelines for both vaccines, including administration to special populations.

Janssen Pharmaceutical Companies of Johnson & Johnson (J&J/Janssen) received emergency authorization from the FDA to distribute their COVID-19 vaccine. This single-shot vaccine was 66.3% effective in the clinical trials at preventing COVID-19 in people who had no evidence of prior infection two weeks after receiving the vaccine. People have the highest protection two weeks after being vaccinated.

Image of a person in a lab holding a vial to illustrate how COVID-19 vaccines are made

How are COVID-19 vaccines made?

Scientists make vaccines by administering one of the following:

  1. An inactive portion of a virus or an inactive portion of a bacterial toxin
  2. A weakened, live portion of a virus
  3. The genetic code (DNA, mRNA, or vectored viruses) for part of the virus

How are the Pfizer and Modern COVID-19 vaccines made?

The Pfizer and Moderna COVID-19 vaccines are both mRNA-based vaccines. mRNA is "messenger" RNA. mRNA is a copy made from DNA that takes the code from the DNA to ribosomes, the cell's protein factories. The cell breaks down the mRNA after it finishes its instructions, and mRNA never enters the cell's nucleus, which is where our DNA (genetic material) lives. 

While mRNA vaccines are a new type of vaccine, the research has been around for decades. Researchers previously studied mRNA vaccines for other infections like the flu, Zika, and rabies. Once the relevant information about the coronavirus that causes COVID-19 became available, scientists started designing the mRNA instructions for our cells to make unique spike protein into an mRNA vaccine. 

A spike protein exists on the surface of the virus that causes COVID-19. COVID-19 mRNA vaccines give our cells instructions to make a piece of this spike protein that triggers an immune response inside our bodies. That immune response make antibodies which protect us from getting infected if the real virus enters our bodies.

Can you get COVID-19 from the COVID-19 mRNA vaccines?

No, you cannot get COVID-19 from the COVID-19 mRNA vaccines. mRNA vaccines do not contain the live COVID-19 coronavirus.

How is the Johnson & Johnson COVID-19 vaccine made?

J&J/Janssen's COVID-19 vaccine uses an inactive virus to deliver SARS-CoV-2 proteins to the body. These proteins are recognized by the body as invaders, signaling the production of antibodies' as an immune response. The Johnson & Johnson COVID-19 vaccine uses an adenovirus (which causes the common cold) as a vector (device used to deliver genetic material) containing the coronavirus's incomplete genetic material. The genetic makeup cannot replicate; therefore, there is no risk of infection of SARS-CoV-2 from the vaccination.

Who should receive the COVID-19 vaccine(s)?

The ACIP recommends that everyone is vaccinated regardless of whether or not they have had COVID-19. The vaccine trials included people who had previously been sick with COVID, and results suggest that the vaccine provides stronger immunity than immunity from having COVID in the first place.

Recommendations for who should receive the vaccine first come from the Centers for Disease Control and Prevention (CDC). Each state then makes its own plan accordingly. Visit the CDC website to choose your state or territory to find your health department and specific state's plan.

The CDC's recommendations come from the Advisory Committee on Immunization Practices (ACIP), an independent panel of medical and public health experts. These recommendations aim to:

  1. Decrease death and severe illness as much as possible.
  2. Preserve functioning society.
  3. Reduce the extra burden that the coronavirus has on people already facing disparities.

The CDC recommends the following rollout for the COVID-19 vaccine:

  • Phase 1a - Healthcare personnel and long-term care facility residents
  • Phase 1b - Frontline essential workers and people aged 75 years and older 
  • Phase 1c - People aged 65—74 years, people aged 16-64 with underlying medical conditions, and other essential workers

The ultimate goal is for everyone to easily get a COVID-19 vaccination as soon as there are enough vaccine quantities available. If you have specific questions about how the COVID-19 vaccine may interact with your particular thyroid condition and health history, be sure to talk to your thyroid doctor.

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What qualifies an underlying medical condition?

People with certain underlying medical conditions may be at increased risk of severe illness (hospitalization, ICU admission, intubation or mechanical ventilation, or death) from COVID-19.

Studies show that adults with the following conditions ARE at increased risk of severe illness from the virus that causes COVID-19:

  • Cancer
  • Chronic kidney disease
  • Chronic obstructive pulmonary disease (COPD)
  • Down Syndrome
  • Some heart conditions
  • Immunocompromised state from solid organ transplant
  • Obesity or severe obesity
  • Pregnancy
  • Sickle cell disease
  • Smoking
  • Type 2 diabetes mellitus

Adults with the following conditions MIGHT be at an increased risk for severe illness from the virus that causes COVID-19:

  • Asthma
  • Cerebrovascular disease
  • Cystic fibrosis
  • High blood pressure
  • Immunocompromised state from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Some neurologic conditions
  • Liver disease
  • Overweight
  • Pulmonary fibrosis
  • Thalassemia
  • Type 1 diabetes mellitus

Am I immunocompromised if I have Hashimoto's thyroiditis?

The short answer is if you have Hashimoto's disease (autoimmune thyroiditis), you are not necessarily immunocompromised or immunodeficient. 

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

However, sometimes people with an autoimmune condition develop more than one, called polyautoimmunity. So, if you have Hashimoto's, you may be at higher risk of developing another autoimmune condition. Some autoimmune conditions like myasthenia gravis or lupus do cause immunodeficiency.

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

So, if you have only Hashimoto's disease, you are not immunocompromised. If you have another illness in addition to Hashimoto's that causes immunodeficiency or requires immunosuppressants, then you may be immunocompromised.

What to know about the vaccine if you have an underlying medical condition

People with underlying medical conditions can receive the mRNA COVID-19 vaccines if they have not had a severe or immediate allergic reaction to any vaccine ingredients. 

For a full list of ingredients, see Pfizer's COVID-19 Vaccine Fact Sheet.
For a full list of ingredients, see Moderna's COVID-19 Vaccine Fact Sheet.

The following groups should still get the vaccine even though there is limited safety data:

  • People who have weakened immune systems
  • People who previously had Guillain-Barre syndrome
  • People who previously had Bell's palsy

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Should I get the vaccine if I have hypothyroidism or Hashimoto's?

Pfizer and Moderna

People with Hashimoto's disease can receive the COVID-19 vaccine. However, you should know that there is currently no specific data available on mRNA COVID-19 vaccines' safety for Hashimoto's patients. Phase 3 of both vaccines included people with autoimmune conditions with no recorded autoimmune flare-ups. Experts will get more information on the risk of inflammatory response for people living with an autoimmune disease like Hashimoto's thyroiditis as more people get the vaccines. 

I recommend that all patients with thyroid disease receive the COVID-19 vaccine, says Paloma Health thyroid doctor, Dr. Sapna Shah. Currently, there isn't any known reason why a patient with thyroid disease should not receive the COVID-19 vaccine, and the benefit of the vaccination far outweighs any potential risk. Patients with a history of allergic reactions should consult their doctor prior to receiving the vaccine.

Johnson & Johnson / Janssen

So far, only patients with rheumatic diseases (a group of autoimmune diseases that cause your immune system to attack your joints, muscles, bones, and organs) represented those with autoimmune disease in the most recent stage of clinical trials. While including patients with rheumatic diseases can give guidance and partial confidence for the use of the Johnson & Johnson vaccine, including more varied population groups moving forward will ensure vaccine efficacy and safety for those living with other autoimmune conditions like Hashimoto's thyroiditis.

Use this interactive tool to get more information on the vaccines:

How are the COVID-19 vaccines administered?

You receive the COVID-19 vaccine by intramuscular injection—a shot in the upper arm.

Both the Pfizer and Modern vaccines require two shots, spaced apart, to get the most protection. The length of time between each shot depends on which vaccine you receive. You should get your second Pfizer dose three weeks (21 days) apart, or your second Moderna dose one month (28 days) apart. Your second dose should come as close to the recommended interval as possible, but no earlier.

The Johnson & Johnson vaccine only requires one shot.

Possible side effects of the COVID-19 vaccines

The most common side effects reported with all COVID-19 vaccines are redness and swelling at the injection site. There may also be pain, tenderness, and swelling of the lymph nodes in the same arm as the injection. Other side effects may include fatigue, headache, muscle pain, joint pain, chills, nausea or vomiting, and fever.

There is a small chance that either vaccine could cause a severe allergic reaction. If this happens, it would usually occur very shortly after getting a dose. Signs of a severe allergic reaction may include difficulty breathing, face or throat swelling, rapid heartbeat, rash all over your body, dizziness, or weakness. 

If you experience a severe allergic reaction, call 9-1-1, or go to the nearest hospital. 

After you receive your COVID-19 vaccination...

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Can lifestyle and nutrition impact the effectiveness of the COVID-19 vaccines?

There is no current research that lifestyle factors can improve vaccine response. However, some factors may decrease your immune system function and vaccine response. Here, some steps you can take to support your immune system function.

Manage your stress levels

Some previous research shows that stress can make you more susceptible to infectious diseases. People who experience psychological stress may also be less likely to experience poor sleep, poor nutrition, or infrequent exercise. 

Limit your use of alcohol

Previous research suggests that smoking or drinking too much may be associated with weakened immunity. The CDC recommends that men have no more than two alcoholic drinks per day. Women should have no more than one alcoholic beverage per day.

Eat a nutrient-dense diet

Focus on eating fresh, whole foods. Refined sugars can spike blood sugar and cause it to crash, increasing your stress levels. Instead, reach for foods full of healthy fats like avocados, eggs, and nuts to support satiety, mood regulation, sleep, and energy. 

Supplement with Vitamin D

Research shows that 80% of patients hospitalized due to COVID 19 had low levels of Vitamin D. Supplementing with vitamin D may support your immune system function, mitochondrial function in your cells, and reduce inflammation. 

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Prioritize quality sleep

Sleep deprivation may make you more susceptible to becoming sick. Getting adequate sleep (seven to nine hours per night) may help your body's immune response when you encounter pathogens. Some studies suggest that a good night of sleep on the nights before and after you receive some vaccines can boost their efficacy. However, those studies did not include the new COVID-19 vaccines.

What to do after vaccination

The CDC updated their COVID-19 guidelines in early March for people who are vaccinated. Fully vaccinated people are safe to: 

  • Gather indoors with other fully vaccinated people without masks
  • Gather indoors with unvaccinated people from one other household without masks
  • Do not need to quarantine after exposure to someone with COVID-19 unless symptoms are present

However, those who are immunocompromised or have an increased risk of severe COVID-19 symptoms should continue to take extra precautions.

It's unclear how long immunity lasts after being vaccinated, how effective these vaccines are against specific variants, and how much vaccines mitigate the spread of COVID-19.

With these considerations in mind, the CDC suggests that each of us continue to take proper precautions to protect ourselves and others.

  • Wear a mask in public places
  • Maintain physical distancing
  • Avoid crowds or poorly ventilated spaces
  • Cover your mouth and nose with your bent elbow when you cough or sneeze
  • Regularly clean your hands with an alcohol-based sanitizer or wash with soap and water
  • Get tested if COVID-19 symptoms occur, even if you're fully vaccinated

Resources to maintain routine thyroid care during COVID-19

You can still maintain routine hypothyroid care via telemedicine while you continue to stay home to protect yourself and others.

Test your thyroid from home

If you can't or don't want to go into the doctor's office for your routine thyroid blood testing, you can use an at-home thyroid blood test kit for simple sample collection and physician-reviewed results sent to you within days.

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Consult via video with thyroid doctors

In response to the pandemic, many doctors and HMOs ramped up their ability to provide consultations by telephone or video chat. Since our beginning, Paloma Health has provided convenient, virtual thyroid care. Schedule an online doctor appointment with Paloma Health to work with a board-certified thyroid doctor who will partner with you to achieve optimal thyroid function.

Fill critical prescriptions

After an online doctor consultation, your Paloma Health thyroid doctor can send prescriptions directly to your preferred local pharmacy. Free services like SingleCare or GoodRx help you to find the best self-pay price for your medication in your area or by mail order. And you can get your meds delivered directly to you with companies like Honeybee Health if you can't or don't want to go to a retail pharmacy.

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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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