Vaccination in Individuals with Thyroid Disorders
Individuals with thyroid disorders can and should receive vaccinations, including routine immunizations, as thyroid disease is not a contraindication to vaccination. 1
General Vaccination Safety
Thyroid disorders (hypothyroidism, hyperthyroidism, autoimmune thyroiditis) are not listed among true contraindications or precautions to vaccination. 1
The only true contraindications applicable to all vaccines include anaphylactic reactions to vaccine components and moderate-to-severe acute illness with or without fever. 1
Conditions inappropriately regarded as contraindications include minor illnesses, mild upper respiratory infections with or without low-grade fever, and current antimicrobial therapy—none of which apply to stable thyroid disease. 1
Important Distinction: Thymus vs. Thyroid Disorders
A critical caveat exists that must not be confused: thymus disorders (thymoma, myasthenia gravis) are contraindications to live vaccines like yellow fever vaccine, but thyroid disorders are not. 1
Yellow fever vaccine is specifically contraindicated for persons with thymus disorders associated with abnormal immune cell function, as 17% of serious adverse events occurred in patients with thymectomies for thymomas. 1
However, thyroid disorders (including autoimmune thyroiditis, hypothyroidism, and hyperthyroidism) do not affect immune cell function in the same manner and are not contraindications. 1
One case report mentioned a patient with polymyalgia rheumatica and hypothyroidism who developed yellow fever vaccine-associated viscerotropic disease, but this was in the context of multiple risk factors including age >60 years, not hypothyroidism alone. 1
Vaccination Recommendations for Thyroid Disorder Patients
All standard vaccinations are recommended for individuals with thyroid disorders following national immunization schedules:
Inactivated vaccines (influenza, pneumococcal, meningococcal, tetanus-diphtheria-pertussis, hepatitis A/B, HPV) can be administered without restriction. 1
Live-attenuated vaccines (MMR, varicella, yellow fever) can be administered unless the patient has concurrent immunosuppressive conditions unrelated to thyroid disease. 1
COVID-19 vaccination is recommended for all patients with chronic medical conditions including thyroid disorders. 1
Special Considerations
If patients with thyroid disorders are on immunosuppressive therapy for concurrent autoimmune conditions (not for thyroid disease itself), vaccination timing should follow immunosuppression guidelines:
High-dose corticosteroids (≥20 mg prednisone daily for ≥2 weeks) warrant caution with live vaccines but not inactivated vaccines. 1
For influenza vaccination specifically, proceed immediately regardless of steroid dose rather than waiting for taper. 2
Patients on rituximab or other B-cell depleting therapies should time non-live vaccines before the next dose when possible, though this relates to concurrent autoimmune disease treatment, not thyroid disease itself. 1
Clinical Pitfalls to Avoid
Do not confuse thyroid disorders with thymus disorders—this is the most critical error to avoid. 1
Do not delay routine vaccinations in patients with stable thyroid disease, as this represents a missed opportunity for appropriate preventive care. 1
Do not withhold influenza or pneumococcal vaccines from patients with hypothyroidism or hyperthyroidism, as these chronic conditions increase vulnerability to vaccine-preventable infections. 1