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Long Covid and Post-Viral Syndromes: What Thyroid Patients Need to Know

Are there solutions to help relieve the 10% of Covid sufferers experiencing "Long Haul Covid?"
Long Covid and Post-Viral Syndromes: What Thyroid Patients Need to Know
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As of 2023, we’re into our fourth year of the Covid-19 pandemic. Around half of all Americans have been infected, and many more are unreported. Experts estimate that 10% to 30% of Covid-19 survivors – 17 million Americans at minimum – report long-lasting, often debilitating symptoms. This chronic condition after recovery from an initial Covid infection has been called “Long Covid,” “post-Covid syndrome,” “Long-Haul Covid,” Post-Acute Covid-19 Syndrome, and Post-Acute Sequelae of SARS CoV-2 infection (PASC), among other names.

Physicians scramble to identify treatments for the often perplexing and complex Long Covid symptoms. Meanwhile, patients are desperately seeking answers that will allow them to overcome Long Covid and restore their health and quality of life. Since members of the thyroid community are also struggling with Long Covid, we turned to two experts for our January 2023 Speaker Series. Integrative physician and best-selling author Jacob Teitelbaum, MD, is considered a foremost expert on post-viral syndromes. Dr. Teitelbaum has dedicated his decades-long career to developing effective approaches for post-viral chronic fatigue syndrome, fibromyalgia, and hormonal conditions, including hypothyroidism. The other guest expert was integrative Paloma physician Andrew Cunningham, MD. Dr. Cunningham shared a wealth of information about diagnosing and treating hypothyroidism and related health conditions and the intersection with Covid-19 and Long Covid.

Ahead, some information about Long Covid and highlights from this seminal Paloma Speaker Series event.

What is Long Covid?

Let’s look at how the U.S. Department of Health and Human Services (HHS) defines Long Covid

“Long Covid is broadly defined as signs, symptoms, and conditions that continue or develop after initial COVID-19 or SARS-CoV-2 infection. The signs, symptoms, and conditions are present four weeks or more after the initial phase of infection; may be multisystemic; and may present with a relapsing-remitting pattern and progression or worsening over time, with the possibility of severe and life-threatening events even months or years after infection. Long Covid is not one condition. It represents many potentially overlapping entities, likely with different biological causes and different sets of risk factors and outcomes.”

One demographic note: Research shows that women face a higher risk of Long Covid than men, with one study showing that adult women are twice as likely to develop the condition. 

What is the impact of Long Covid?

Studies have reported that many other serious, often chronic, and symptomatic health conditions are also triggered by Long Covid, including:

  • Heart disease
  • Lung disease
  • Kidney disease
  • Pancreatic dysfunction, including diabetes
  • Neurocognitive disorders, including dysautonomia and cognitive impairment
  • Thyroid dysfunction, including changes in thyroid gland function, thyroiditis, and autoimmune thyroid disease
  • Gastrointestinal problems
  • Blood coagulation disorders
  • Immune dysfunction, including autoimmune disease, and Mast Cell Activation Syndrome (MCAS)
  • Reproductive dysfunction.

Additionally, research published in early 2023 reported an increased risk of developing myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and dysautonomia after Covid.

According to a Kaiser Family Foundation January 2023 report, 79% of Long Covid patients surveyed reported that their symptoms resulted in “limitations to their day-to-day activities,” and “27% characterize the limitations as significant.” These findings translate to some 16 million Americans struggling with activity limitations due to Long Covid.

A significant subset of Long Covid patients is also unable to work. Analyzing the current COVID-19 case numbers and the workforce participation rate, Harvard economist David Cutler has estimated that 3.5 million people are out of work due to Long Covid. He estimates that lost wages total $200 billion per year.

According to a report from the U.S. Department of Health and Human Services (HHS):

“Long Covid will be around long after the pandemic subsides, impacting our communities, our health care system, our economy, and the well-being of future generations.”

What are the symptoms of Long Covid?

According to research, one to two years after a COVID-19 infection, the clinical manifestations and symptoms of Long Covid include: 

  • Fatigue is the most common symptom in more than 90% of Long Covid patients.
  • Neurocognitive disorders affect more than 75% of Long Covid patients. Symptoms include confusion, memory, and focus problems (known collectively as “brain fog”), as well as behavioral changes, anxiety, agitation, seizures, dementia, and psychosis.
  • More than 50% of Long Covid patients experience muscle and joint pain, shortness of breath, breathing difficulties, and anxiety.
  • Finally, around 40% of patients experienced cardiac symptoms like chest pain and palpitations, digestive problems, and changes in their senses of taste and smell, including loss of taste and olfactory dysfunction.

Another study of more than 1.3 million people who had COVID-19 found that patients face an increased risk of neurocognitive disorders for at least two years after the initial infection.

Long Covid appears to be a new – but familiar – post-viral syndrome

Before the appearance of COVID-19 and Long Covid, doctors acknowledged different viral and bacterial infections – Epstein-Barr Virus (EBV), Human Herpes Virus 6 (HHV-6), cytomegalovirus, enteroviruses, and Lyme disease, among others – can linger in patients. These viruses cause a complex mix of symptoms referred to as post-viral syndrome. Post-viral syndrome is characterized by profound fatigue, frequent headaches, muscle and joint pain, brain fog, difficulty concentrating, memory problems, post-exertional malaise (extreme fatigue after physical activity), as well as anxiety and depression.

In some cases, a unique cluster of post-viral symptoms has given rise to the classification of a new condition, such as ME/CFS, and now, Long Covid.

Viral infections also appear to have the ability to, in some people, reactivate latent viruses as part of a post-viral syndrome. Reactivated EBV, for example, has been observed in patients with ME/CFS, and now, Long Covid – as well as in autoimmune Hashimoto’s thyroiditis.

Are there treatments for Long Covid?

When it comes to post-viral syndromes, a post-viral condition like ME/CFS – and now, Long Covid – the discouraging news is that conventional medicine doesn’t have agreed-upon treatment protocols or medications. The typical advice given by many doctors is simply to rest, reduce daily activities and conserve energy, eat well, get some physical activity, eat a balanced and healthy diet, practice stress reduction techniques, and get mental health support. Medications may be offered to deal with specific symptoms like pain, sleep problems, or depression, but the root causes are not addressed.

This is where Jacob Teitelbaum, MD, our guest expert at the Paloma Speaker Series on Long Covid, comes in.

During the Speaker Series event, Dr. Teitelbaum told the story of his own battle with ME/CFS, which temporarily derailed his medical school attendance and left him homeless. After turning to natural and holistic medicine for his recovery and getting his medical degree, Dr. Teitelbaum set the course for his future medical career:

“I’ve spent the last 45 years focusing on making effective treatment available for everybody with unexplained fatigue, fibromyalgia, chronic fatigue syndrome, and post-COVID, which is simply post-viral chronic fatigue syndrome.”

Today, he is one of the most renowned physicians in the field of post-viral illness. His bestselling book, From Fatigued to Fantastic, first published in 1998 – with the fourth edition published in 2020 – documents his comprehensive and proven “S.H.I.N.E.” protocol for ME/CFS, fibromyalgia, and post-viral syndromes. The acronym S.H.I.N.E. stands for Sleep, Hormones, Infections, Nutrition, and Exercise, and the protocol combines medical treatment, nutritional supplements, and lifestyle changes to address these five recovery factors.

Of interest to thyroid patients is that in his S.H.I.N.E. Protocol, Dr. Teitelbaum identified the thyroid as a vital hormonal player in post-viral recovery and has incorporated hypothyroidism treatment as an integral part of his approach.

Since 2020, Dr. Teitelbaum has been applying his decades of research and knowledge to the issue of how to treat Long Covid, working with patients on recovery, and conducting research into the S.H.I.N.E. Protocol’s effectiveness in Long Covid patients. And there’s good news. While COVID-19 is considered a “novel” coronavirus, the post-viral syndrome that has now been labeled Long Covid is a familiar – and treatable – condition, according to Dr. Teitelbaum!

What is the relationship between a post-viral syndrome like Long Covid, and Hashimoto’s/hypothyroidism?

During the Speaker Series conversation, Dr. Teitelbaum explains that with a post-viral syndrome like Long Covid, “you’re getting a suppression of the key circuit breaker in the brain, called the hypothalamus, that controls sleep. You won’t always see it in the first six to eight months. But over time, the inability to get restorative sleep becomes a hallmark. You’re also going to see orthostatic intolerance, where you stand up and feel lightheaded, and your pulse goes up 20 to 30 beats per minute, and the blood pressure goes down. This circuit also controls your entire hormone system.”

Dr. Teitelbaum went on to explain the link between post-viral syndrome, Hashimoto’s, and hypothyroidism:

“Anything that drops energy when your body’s under stress is more likely to trip that ‘hypothalamic circuit breaker.’ The hypothalamus and pituitary control thyroid function. Once you flip the circuit breaker, you’ll get a drop in thyroid function. Your body is registering low energy, and it’s going to put you in an almost hibernation state, converting your thyroid hormone into Reverse T3, which makes your symptoms worse.”

Dr. Cunningham also pointed out that there are many overlaps in terms of the strategies used to manage Hashimoto’s patients and a post-viral condition like Long Covid:

“It’s about trying to help the body’s stress response, with stress reduction, keeping cortisol levels on a good rhythm, restorative sleep, and dietary guidance that helps keep immune dysregulation under better control.”

Dr. Teitelbaum had some advice for people who have Covid – including Hashimoto’s and hypothyroid patients – who want to avoid Long Covid as a complication:

“I find that people who try to work through deadlines at work, and they can’t stop, and they try to push through the COVID are the ones who are more likely to get a post-viral syndrome. So, rest! Hydrate! Sleep! And make sure zinc and vitamin D are optimized!”

There’s good news on the link between Long Covid and Hashimoto’s thyroid disease, however. A major study found a higher rate of anti-thyroid antibodies (anti-TPO) – also known as Thyroid Peroxidase antibodies or TPOAb – after Covid infection. They also found that “symptom resolution was more likely among patients with positive anti-TPO at the time of reassessment, suggesting a potential protective role of anti-TPO in long COVID.”

Which supplements are recommended for Long Covid?

Dr. Teitelbaum mentioned zinc and vitamin D, two of the many immune-supporting supplements that are part of the S.H.I.N.E. Protocol. During the Speaker Series, the doctors went into more detail on Vitamin D and adaptogenic herbs for adrenal support.

Dr. Cunningham spoke about the importance of vitamin D in supporting thyroid patients who want to improve their immune health to avoid – or recover from – Covid or Long Covid.

“Vitamin D deficiency creates an increased risk for autoimmunity, and it’s received a lot of press for its implications in COVID. A lot of people wanted to get their vitamin D levels up when they realized that they might be more predisposed to getting Long Covid.”

Both doctors also emphasized the importance of adrenal support for people with any post-viral condition like Long Covid and in many Hashimoto’s patients.

Dr. Cunningham regularly recommends herbal adaptogens in his practice.

“There are thousands of years of history of using ashwagandha, ginseng, rhodiola, and eleuthero (Siberian ginseng.) These adaptogens are an important part of immune resilience through this flare of respiratory infections that we’re all globally living with right now. And those supplements also help people with autoimmunity, and they help the rest of us who are just under general stress.”

Dr. Teitelbaum discussed the results of studies he conducted that found a benefit to combining two adrenal adaptogens: ashwLagandha and rhodiola. “We saw about a 60% increase in increase in energy. We did another study using a combination of those with ribose. And what we saw was an 89% increase in stamina!”

You may see warnings against ashwagandha for autoimmune patients, but Dr. Cunningham addressed these concerns.

“Ashwagandha is in the nightshade family of plants, which also includes tomatoes, bell peppers, and eggplant. Nightshades are a known trigger for some people with autoimmune conditions. This has been generalized, however, and ashwagandha has been given a bad name, but I actually don’t see a contraindication with ashwagandha. For most people with hypothyroidism, I think the benefit is far greater than the risk.”

More on Dr. Teitelbaum’s S.H.I.N.E. Protocol

Dr. Teitelbaum’s S.H.I.N.E. Protocol addresses energy production. It includes strategies to optimize sleep, address hormonal imbalances in the thyroid and adrenals, and treat other underlying infections – such as Candida, SIBO, and others. The protocol also includes approaches for nutritional support and moderate exercise to maintain conditioning. 

The S.H.I.N.E. Protocol has gone through randomized, double-blind, placebo-controlled studies and was found to be highly effective. According to Teitelbaum, the research showed that “91% of people improve, with an average 90% increase in quality of life. This is incredibly treatable!”

Getting doctors on board

One of the biggest challenges with treating Long Covid and other post-viral conditions is the need for more doctors who are up to speed on the approaches that work.

Dr. Teitelbaum urges patients to seek doctors who already know how to treat ME/CFS, post-viral syndromes, and Long Covid.

“We’re not lacking effective treatment. What’s lacking is effective physician education. Doctors’ minds may open, but you’re not going to browbeat them into it, nor should a doctor do anything they’re uncomfortable with. See doctors who already know how to do the treatments you’re seeking.”

Dr. Cunningham also highlighted the value of good communication and patient engagement with their doctors. He suggests you “let them know that you respect their opinion, and you would like to understand more.” Dr. Cunningham also encouraged patients to bring up treatment ideas. He described how, early in his practice, he wasn’t as familiar with using natural desiccated thyroid drugs, T3 drugs, and Low Dose Naltrexone (LDN).

“But when patients are requesting certain treatments, hopefully, doctors get the message and learn more about it. At some point, you just have to jump in and start getting the anecdotal experience. Open communication, an attitude of partnership and inquiry, and curiosity are the best ways that both sides can approach it.”

In his work as a Paloma provider, Dr. Cunningham now offers the full range of treatment options for his Hashimoto’s and hypothyroid patients.

A note from Paloma

We encourage you to watch the video featuring the full discussion with Drs. Teitelbaum and Cunningham for a fascinating and groundbreaking look at what is likely to be the future of treatment for Long Covid.

More information about the S.H.I.N.E. Protocol and how to implement it can be found in Dr. Teitelbaum’s book, From Fatigued to Fantastic, and at his website: Dr. Teitelbaum also offers free informational fact sheets on various approaches to post-viral symptoms and treatments that can be requested by emailing

Dr. Andrew Cunningham is one of the many knowledgeable, thyroid-savvy doctors available for your hypothyroidism care through Paloma. Paloma practitioners work with you to not only carefully diagnose, manage, and treat hypothyroidism and relieve your symptoms but help support and enhance your immune health and quality of life.

You may also want to explore some of our other helpful articles on Covid, including:

Thyroid care online

Dealing with Hypothyroidism?  Video chat with a thyroid doctor

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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