Is it safe to administer a flu shot to an 87-year-old individual with Hashimoto's (autoimmune thyroiditis) disease?

Influenza Vaccination in an 87-Year-Old with Hashimoto's Thyroiditis

Yes, it is safe and strongly recommended to administer the flu shot to an 87-year-old patient with Hashimoto's thyroiditis. This patient falls into a high-priority group for influenza vaccination based on age alone, and Hashimoto's thyroiditis is not a contraindication to vaccination. 1

Age-Based Priority for Vaccination

• Persons aged ≥65 years are at substantially increased risk for severe influenza complications, hospitalization, and death, making them a primary target group for annual vaccination. 2, 1
• The benefits of influenza vaccination in preventing serious illness, hospitalization, and death substantially outweigh any possible risks in this age group. 2
• Among elderly persons, influenza vaccine is 30-70% effective in preventing hospitalization for pneumonia and influenza, and 80% effective in preventing death in nursing home residents. 2
• Vaccination reduces influenza incidence from approximately 6% to 2.4% in older adults, and reduces influenza-like illness from 6% to 3.5%. 3

Hashimoto's Thyroiditis and Vaccination Safety

• Hashimoto's thyroiditis (autoimmune thyroiditis) is not listed as a contraindication or precaution to influenza vaccination in any current ACIP guidelines. 2
• Autoimmune thyroid disease does not constitute an immunocompromised state that would alter vaccine recommendations or safety profiles. 2
• The only autoimmune condition that represents a precaution is a history of Guillain-Barré Syndrome within 6 weeks of previous influenza vaccination, which does not apply here. 2

Vaccine Selection for This Patient

• Any age-appropriate inactivated influenza vaccine (IIV) formulation is acceptable for persons ≥65 years, including standard-dose, high-dose, trivalent, quadrivalent, adjuvanted, or recombinant (RIV4) vaccines. 2
• Live attenuated influenza vaccine (LAIV) should not be used in persons aged ≥65 years. 2
• The vaccine should be administered intramuscularly in the deltoid muscle. 2

Safety Profile in the Elderly

• Influenza vaccines are safe in elderly patients, with minimal systemic reactions. 2
• Fever occurs in approximately 2.5% of vaccinated elderly (compared to 1.6% with placebo), and nausea in 4.2% (compared to 2.4% with placebo). 3
• Immediate allergic reactions are rare and typically related to egg protein hypersensitivity, not autoimmune conditions. 2
• The estimated risk of Guillain-Barré Syndrome is approximately one additional case per million persons vaccinated, which is substantially less than the risk of severe influenza complications. 2

Clinical Bottom Line

This 87-year-old patient should receive annual influenza vaccination regardless of Hashimoto's thyroiditis status. The patient's advanced age places them at high risk for influenza-related morbidity and mortality, and there is no evidence that autoimmune thyroid disease increases vaccine-related risks or contraindicates vaccination. 1, 2