Issued 5 March 2020 (updated 4 May 2020)

At this unprecedented time, we would like to extend our thoughts to everyone in the UK who has been directly affected by COVID-19 and to all of us who are grappling to come to terms with this rapidly changing situation. We would also like to express our support and gratitude to all the health- and key workers out there doing an amazing job to keep us safe in our time of need.

We are very aware of how worrying a time this is for everyone. The huge amounts of information in circulation can sometimes seem overwhelming and confusing. Understandably we have received very many enquiries from people living with thyroid disorders about COVID-19 and the possible impact on your health. We are thankful to the medical professionals from the British Thyroid Association (BTA) who have worked with us to provide some answers to your questions. We will continue to monitor the situation very closely and will update this information accordingly.

FAQs about thyroid disease and COVID-19

Thyroid cancer and COVID-19

Thyroid eye disease and COVID-19 FAQs

About COVID-19

COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus. The UK Chief Medical Officers have now raised the risk to the UK to high. Typical symptoms include:

a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature

a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)

A change or loss of sense of taste or smell

The UK government has issued specific advice on

staying at home and safe social distancing

How does COVID-19 spread?

In common with other viruses, it is thought the virus spreads via droplets in the cough or sneeze of an infected person. It is also probably spread by touching an infected person or surfaces and objects they have come into contact with.

Who are at risk groups?

The UK government has identified certain groups as being at increased risk of severe illness from COVID-19. It has issued specific guidance about:

Are individuals with autoimmune thyroid disease at increased risk of COVID-19 infection?

COVID-19 is a new virus, so we have no information on how it affects individuals with thyroid disease. However, thyroid disease is not known to be associated with increased risk of viral infections in general, nor is there an association between thyroid disease and severity of the viral infection.

Many people are asking whether having an autoimmune thyroid disease means you are immunocompromised. We can confirm it does not. The part of the immune system that’s responsible for autoimmune thyroid conditions is separate to the immune system that’s responsible for fighting off viral infections, such as COVID-19. Patients who are classified as having a weakened immune system (immunocompromised) are typically those with conditions such as leukaemias, HIV and AIDS, or who are on medicines such as high-dose steroids, immunomodulatory drugs for rheumatoid arthritis or multiple sclerosis, cancer chemotherapy or following organ transplantation.

Does being on medication for my thyroid disorder suppress my immune system?

Neither levothyroxine, nor carbimazole nor propylthiouracil, are immunomodulatory therapies. i.e. they do not change nor weaken your immune system. However, some people with thyroid eye disease will be on high doses of steroid medication which can suppress the immune system (see next question below).

What happens if I am on steroid medication, for example, for my thyroid eye disease?

Some patients with thyroid eye disease will be on steroid medication at doses which suppress their immune system. Others will be taking daily immunosuppressive drugs such as mycophenolate (MMF) or will have received rituximab in the last 9-12 months. If you are one of these patients you will be in the group of people who are at increased risk of severe illness from COVID-19. Therefore, you should be especially strict in following the government advice about staying at home. (See links at bottom of this statement). In some cases your doctor will discuss with you that it could be better to temporarily suspend high-dose steroid or MMF treatment until the pandemic is over. This will depend on the severity of your eye problem.

Are patients who have had radioiodine therapy or thyroid surgery at higher risk of COVID-19 infection?

There is no evidence that patients who have recently had radioiodine therapy or thyroid surgery for benign (non-cancerous) thyroid disease are at increased risk of general viral (and therefore COVID-19) infection.

If my thyroid disease is not well managed, does this affect my infection risk?

Most patients’ thyroid disease will be well managed i.e. their thyroid levels remain stable and they feel well. Others have ‘poorly controlled’ thyroid function which can mean their thyroid function levels fluctuate as they are not on the correct balance of thyroid hormone replacement and they still experience symptoms. If this applies to you, your doctor may be able to adjust your dose of levothyroxine until you feel better (and your GP should refer you to a specialist if they can't restore your wellbeing. NOTE: This will depend on the availability of healthcare staff over this period). There is currently no evidence that those with ‘poorly controlled’ thyroid disease are more likely to contract viral infections in general.

However, it is possible that patients with ‘uncontrolled’ thyroid disease (these are people who have very recently started medication or who do not take their thyroid medication as prescribed) may be at higher risk of complications from any infection. This is especially the case for those with an overactive thyroid (otherwise known as hyperthyroidism or thyrotoxicosis). We strongly recommend patients with thyroid disease continue taking their thyroid medication(s) to reduce this risk.

If I am taking antithyroid drugs for my overactive thyroid, am I at higher risk of infection?

Antithyroid drugs (ATDs) are not known to increase the risk of infection, unless they result in ‘agranulocytosis’. This is a very rare side effect of antithyroid drugs which occurs when the number of white cells in the body lowers dramatically. It typically presents with a sore throat, mouth ulceration, fever, flu-like illness - see more information in the question below.

The BTA does not consider patients on ATDs to be at higher risk of contracting COVID-19 or of developing more severe disease should they contract the infection.

A patient infected with COVID-19 can continue with their antithyroid drugs unless they have an abnormally low white blood count (agranulocytosis) with a granulocyte count of <1.0 x 109/L).

If I develop agranulocytosis due to being on antithyroid drugs (ATDs), could it be confused with COVID-19 symptoms?

Patients taking ATDs have a small risk of developing agranulocytosis, although this side effect is extremely rare. Research shows that the chance of a person taking carbimazole developing agranulocytosis is between 0.2-0.5%. See our Guide to Antithyroid drug therapy to treat hyperthyroidism for more details.

Symptoms of agranulocytosis (sore throat, mouth ulceration, fever, flu-like illness) may overlap with symptoms of COVID-19 infection (fever, new continuous cough, flu-like illness) making it very difficult, if not impossible, for patients and doctors to distinguish between the two.

The BTA recommends that patients on ATDs who develop symptoms which may suggest agranulocytosis should STOP the ATDs and have an urgent full blood count. This may need to be with your own GP, at the A&E department or via your endocrinologist or endocrine specialist nurse. In some circumstances, doctors may also test you for COVID-19 at the same time.

In the event of a doctor not being able to perform a full blood count, it is suggested patients stop the ATDs and restart one week later if symptoms have cleared up. If symptoms worsen during the period off ATDs or recur after recommencing the drug, the patient should seek urgent medical attention. In such situations performing a full blood count is essential. Please note that in all other circumstances patients must NOT stop taking their ATDs unless instructed to do so by a doctor.

Is it safe to defer definitive (radioactive iodine or thyroid surgery) treatment for hyperthyroidism?

The NHS has instructed hospitals to postpone all non-urgent surgery, so it is unlikely that those awaiting thyroidectomy for benign disease will have thyroid surgery during the outbreak. In addition, it is highly likely that radioactive iodine therapy for hyperthyroidism will also need to be deferred. Most hospital trusts have already cancelled planned, elective radioactive iodine treatments. The BTA would like to reassure patients and doctors that in most cases, these measures are acceptable and safe.

If you have recently undergone radioiodine treatment for hyperthyroidism, you may need to start levothyroxine treatment if you start to develop symptoms of hypothyroidism. In these circumstances you should seek advice from your doctor about when and how to monitor your thyroid function. If you have started levothyroxine treatment you will need to have follow up blood tests to ensure you are on the correct dose.

I’m worried I won’t be able to get a full blood count and this will affect how my hyperthyroidism is treated.

Over the coming weeks it is possible that thyroid function tests will be difficult to perform. In this exceptional circumstance, doctors will consider starting patients on a ‘block and replace’ course of treatment. This is where antithyroid drugs are given to block the thyroid from producing any thyroid hormone and then levothyroxine is given to replace the thyroxine the body should be producing. This is a way of maintaining very stable thyroid function in most people, provided you take the tablets as requested.

As non-urgent appointments are being cancelled are there any alternatives to face to face consultations for thyroid disease?

Subject to ongoing availability of healthcare staff, many doctors will be able to offer patients some telephone or video consultation over this period. If you are feeling well, then please don’t contact your endocrinologist as most endocrinologists will be redeployed some or all of the time to look after COVID-19 patients. However, if you are feeling poorly, please contact your consultant’s secretary or the endocrine specialist nurse for advice. In many circumstances a blood test followed by a telephone or email consultation will be possible.

Thyroid cancer and coronavirus

Further information is available on thyroid disorders and COVID-19

Endocrinology in the time of COVID-19: Management of hypo- and hyperthyroidism European Society of Endocrinology, May 2020

British Thyroid Association (BTA)

Society for Endocrinology (SfE) COVID-19 resources for managing endocrine conditions

Thyroid Eye Disease Charitable Trust - COVID-19 and thyroid eye disease FAQs for patients (dated 29.03.20)

Where can I get up-to-date information?

NHS website for general information and answers to common questions about coronavirus (COVID-19)

NHS 111 online coronavirus (COVID-19) service can tell you if you need medical help and advise you what to do

GOV.uk for latest news and advice

GOV.uk information on shielding and protecting the very vulnerable

GOV.uk information on staying alert and safe (social distancing)

Getting support for the extremely vulnerable

NHS information about seasonal flu vaccines for people with medical conditions

Flu jabs, vaccinations and thyroid disorders

BTF Guide to Antithyroid Drug Therapy to treat hyperthyroidism

More information about thyroid disorders and support available in the UK is available on the BTF website