It is very understandable that during this period of global fear and panic most thyroid patients would be extra worried about their health with regards to their chances of contracting the coronavirus, managing both an infection and their thyroid disease, and the risk involved in attending hospitals  and taking thyroid medications. These concerns came about due to the information that people with some underlying health conditions will be at higher risk of contracting the virus and experience difficulties in managing their infection. The thyroid Ghana Foundation has compiled information to help patients during this pandemic by addressing some frequent questions that have been raised by our members on the coronavirus outbreak and thyroid disease.

Here are some questions, answers and guidelines to help thyroid patients stay safe during this pandemic.

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

COVID -19 is a new virus, so there is currently 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. We know there have been several tests and observations that have been made after the outbreak of the virus and yet none have isolated thyroid patients as a group of interest. This could be due to the fact that an autoimmune thyroid disease does not make one immunocompromised. 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 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 patients with thyroid eye disease will be on high doses of steroid medication which can suppress the immune system

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

Discuss your treatment with your doctor. Depending on your medication, dosage or severity of your condition it may be necessary to suspend treatment for your thyroid eye disease until the pandemic is over.

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

There is no evidence to show that radioiodine therapy or thyroid surgery for benign (non-cancerous) thyroid disease would put a patient at higher risk of COVID-19 infection. However, rules for staying safe during this period must be strictly adhered to both prior  and post thyroidectomy. It would be very difficult for a patient to manage a COVID-19 infection while recovering from thyroid surgery, especially if the infection brings symptoms such as cough. This may affect the healing process and cause the patient a great deal of pain. Patients who are scheduled for thyroidectomy who contract COVID-19 may be prevented from undergoing the procedure since they may not get clearance from the cardiovascular unit.

In some countries with high COVID-19 infections, hospitals have been instructed to postpone all non-urgent surgery during the outbreak to focus resources on fighting the pandemic and to prevent new infections by those visiting the hospitals for unrelated illnesses. But that is not the case in Ghana now. The Surgical department of the Korle-Bu teaching hospital will carry out scheduled thyroid surgeries till otherwise instructed by the Ministry of Health. However, patients in recovery would be required to adhere strictly to the guidelines for preventing corona virus infection as for the reasons stated above.

Is it safe to visit the endocrine clinic during this pandemic?

Visiting the hospital may not be too safe for now.  However, the Endocrine clinic at the Korle-Bu teaching hospital has put in the necessary infection control measures to ensure staff and patient safety during this COVID-19 period. The Clinic still runs on Tuesday mornings with the added option for telephone consultations for patients who are unable to visit the premises. If you are feeling well, then please don’t contact your endocrinologist as they may be busy attending to COVID-19 patients. However, if you are feeling very unwell even prior to a scheduled visit, then please do not hesitate to call the clinic  for advice. Please make sure you have all you need, blood tests, etc. before your hospital visit to avoid multiple trips to the clinic on the same issue. Patients who attend their clinics elsewhere should call the hospital to find out if there are special arrangements for the period. Also ensure that you always wear face masks when visiting the hospital.

Is it safe for thyroid patients to wear face masks?

There are different types of face masks. (medical and non-medical). The medical type are designed to be worn by health care professionals who are at a greater risk of exposure to the virus and are to be worn for a specific period. These are different from the non-medical ones which the general public are encouraged and expected to wear which are not associated with oxygen/ hypoxia problems.

Face masks (non medical) are generally safe for thyroid patients and would be effective in preventing spread of infection from wearers to others and vice versa. Please ensure you were them appropriately in public areas and also avoid touching them.

Safety Guidelines for Thyroid Patients

Thyroid patients should adhere to all the rules for staying safe during this period.  However, patients especially those who experience shortness of breath must regulate the wearing of face masks.

In addition, all thyroid patients must:

• Ensure they take their medication and manage their condition properly.

• Ensure they do not run out of medication which could lead to trips to the drug store especially during a lockdown.

• Only take your thyroid tests at standardized laboratories which adhere to COVID-19 safety guidelines.

• Ensure you visit the clinics on time for your appointments and carry along all your required lab results.

• Take medications exactly as prescribed.

• If experiencing symptoms such as fever, cough, shortness of breath, kindly contact the COVID-19 hotline and the endocrine clinic.

• Kindly disclose your thyroid condition when speaking with the COVID-19 response team

References

Excerpts of articles from:

British Thyroid Foundation

Thyroid Foundation of Canada

Hospital for Special Care

Reviewed by:

                                                       Dr. Mrs. Josephine Akpalu

                                                       (Head, Endocrine Unit, KBTH)