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Can The Flu Shot Trigger Graves’ Disease and Hashimoto’s Thyroiditis?

Around this time of year I always have a few of my patients ask if they should get the flu shot.  I personally have never had the flu shot, and my wife and two daughters have never had the flu shot, and so this should give you a pretty good idea of what I think about this vaccine.  Whereas years ago the flu shot was only available by going to your medical doctor, these days you can walk into a local pharmacy and get a flu shot.  And I realize that many corporations encourage their employees to get the flu shot, while some people have jobs which require them to get the flu shot.

Although I have my biases, rather than use this entire post to bash the flu shot, what I’d like to do is go ahead and discuss the benefits and risks of getting this vaccine.  This way you can make an informed decision, although I encourage you to do some research on your own.  I’ll then talk about some of the more commonly recommended flu shots, along with some of the ingredients.  And then towards the end of this post I’ll give my opinion as to whether those with Graves’ Disease and Hashimoto’s Thyroiditis should receive this shot annually.

The influenza (flu) shot is unique when compared with other vaccines in that this vaccine needs to be updated on a periodic basis to match the vaccine strains with the current influenza strains.  In other words, every year or two different influenza vaccines need to be formulated with different virus antigens.  But as you’ll read, the main concern isn’t with the virus antigens that are in the vaccine, but the other ingredients.

Reasons To Consider Getting The Flu Shot

1. Influenza can sometimes lead to hospitalization, and in rare cases death.  According to the CDC website, flu-related hospitalizations since 2010 ranged from 140,000 to 710,000, while flu-related deaths are estimated to have ranged from 12,000 to 56,000.  However, this apparently includes cases of pneumonia, and the reason is because some deaths related to influenza are due to secondary complications, although not all cases of pneumonia are related to influenza.

2. In some cases getting the flu vaccine can reduce your risk of getting the flu virus, as well as spreading it to others.  Of course when I talk about reasons to consider avoiding the flu shot I’ll talk about how there are different strains of the flu, and as a result, getting the flu shot won’t significantly reduce your risk of getting Influenza.

3. If everyone gets the flu shot annually at their local pharmacy then this will greatly decrease the chance of places like Walgreens and CVS going out of business.  Okay, I admit that I’m being a wise guy here, but the reason I’m bringing this up is because I came across a journal article which looked to compare the cost benefit of receiving the flu shot.  It mentioned that an influenza immunization program will be cost beneficial for employers when more than 37% of employees receive vaccines in non-traditional settings such as pharmacies (1) [1]. But when you look under “competing interests” you’ll notice that this research was funded by Walgreens, and that the authors of the journal article are employed or contracted by Walgreens.  This is why you need to be extremely careful when reading the research.

Reasons To Consider Avoiding The Flu Shot

1. There are different strains of the flu.  Because of this, getting the flu shot won’t completely protect you from getting the flu.  In fact, it’s not uncommon for people to get the flu, even after getting the flu shot.

2. There are harmful ingredients in the flu vaccine.  To no surprise, the CDC doesn’t talk about some of the harmful effects of the ingredients in this vaccine.  While it is true that these ingredients are present in small amounts, this doesn’t mean they are safe.  In addition, one also needs to consider the synergistic effects of these chemicals.  In toxicology, synergism refers to the effect caused when exposure to multiple chemicals at as time results in health effects that are greater than the effects of the individual chemicals.  Common ingredients found in vaccines overall (not just the flu shot) include formaldehyde, mercury, egg protein, aluminum, neomycin, monosodium glutamate (MSG), and polysorbate 80.  The good news is that the flu shot doesn’t include all of these, and later in this post I’ll discuss the ingredients that are more specific to this vaccine.

3. Side effects are common when getting the flu vaccine.  Most of the time the side effects are minor, such as local swelling, redness, and pain at the site of the injection.  Other symptoms that have been reported include headaches, nausea, fatigue, muscle pain, and neuropathy, just to name a few.

4. Vaccines can potentially trigger or exacerbate the autoimmune response.  I’ll discuss the research shortly, and while this does seem to be rare, it still should make anyone with an existing autoimmune thyroid condition think twice about getting the annual flu vaccine.

5. You can protect yourself naturally from the flu.  While it’s true that doing things to improve your immune system health won’t guarantee that you won’t get the flu, the same is true when getting the flu vaccine.  Plus it won’t hurt to eat a good diet, improve your stress handling skills, do things to improve the health of your gut (where most of your immune system cells are located), make sure you have healthy levels of vitamin D, take vitamin C and other nutrients and herbs that can improve your immune system health, etc.

Some reading this might also be familiar with nosodes, which is a homeopathic alternative to vaccines.  I can’t say that I have a great deal of knowledge in this area, and while you can find some information about this online, if this interests you then it probably would be best to work with a homeopathic practitioner.  If anyone reading this has experience with using homeopathy as a substitute for the flu shot (or any other vaccine) please feel free to share your experience in the comments section below.

How Does The Flu Vaccine Work?

Vaccines usually use either live attenuated pathogens (i.e. viruses), or inactivated pathogens.  Live attenuated vaccines elicit strong and cellular antibody responses and usually result in immunity against the pathogen that lasts for decades (2) [2].  On the other hand, many vaccines that use inactivated pathogens include substances called adjuvants.  As of writing this blog post, all flu vaccines currently consist of the inactivated influenza virus, although the only flu vaccine that has an adjuvant is FLUAD, which is a trivalent vaccine that has an adjuvant called MF59, which consists of squalene oil.  This vaccine is only approved for those people who are 65 years and older.  The nasal spray influenza vaccine used a live attenuated virus, but the CDC stopped recommending this.

If You Choose To Get The Flu Shot, Which Ones Are Available?

This changes every year, but as of writing this blog post there are injectable influenza vaccines which include both inactivated influenza vaccines and recombinant influenza vaccines.  Although there is a nasal spray flu vaccine, as I just mentioned, the CDC recommends not using this during 2016-2017.  Flu vaccines can also be trivalent or quadrivalent.  Trivalent flu vaccines are approved for people 65 and older and protect against three different strains of the flu virus.  Quadrivalent vaccines are approved for people 18 through 64, and they protect against four different strains.

What Are Adjuvants?

I briefly mentioned adjuvants earlier, and an adjuvant is an ingredient that is added to a vaccine in order to help create a stronger immune response by the person who receives the vaccine.  This is especially true when a vaccine consists of an inactivated bacteria or virus, which is the case with most vaccines.  And so the adjuvant helps to enhance the immune response against the inactivated virus that is in the vaccine, which in turn will cause the person to develop antibodies against the virus.   As I have already mentioned, although the flu vaccine uses inactivated viruses, only one type (Influenza FLUAD) uses an adjuvant.

What Ingredients Are Included In The Flu Vaccine?

This isn’t an easy question to answer, mainly because there are a few different types of flu vaccines.  If you check out this document by the CDC [3] you’ll see that they have eleven different flu shots listed, and the ingredients will vary with each one.  I had my staff person Kate call a local CVS and Walgreens to find out which flu vaccine they use, and here is what they told her:

CVS: They mainly use Fluarix, but they also use Flucelvax.

Walgreens: They told Kate that they use Flucelvax and Fluvirin.

Here are the ingredients of these three vaccines:

1. Influenza Fluarix (GSK): octoxynol-10 (TRITON X-100), α-tocopheryl hydrogen succinate, polysorbate 80, hydrocortisone, gentamicin sulfate, ovalbumin, formaldehyde, sodium deoxycholate, sodium phosphate-buffered isotonic sodium chloride

2. Influenza Flucelvax: Madin Darby Canine Kidney (MDCK) cell protein, protein other than HA, MDCK cell DNA, polysorbate 80, cetyltrimethlyammonium bromide, and β-propiolactone

3. Influenza Fluvirin: ovalbumin, polymyxin, neomycin, betapropiolactone, nonylphenol ethoxylate, thimerosal

Let’s take a look at some of these ingredients included in these vaccines.  Just as a reminder, not all of the ingredients listed below are included in all of the different flu vaccines.  As a result, if you do choose to get the flu shot you might want to find out which type will be used so you can first read the ingredients.  If you are required by your job to get the flu vaccine it still might be worth looking into the ingredients, as while all of the flu vaccines have chemicals, some are worse than others.  And you might have the option of choosing a specific flu vaccine, and if not, perhaps they will allow you to get one on your own and then simply provide the necessary documentation.  For example, Flucelvax doesn’t include either thimerosal or formaldehyde, and so this might be the best option, although it does include Madin Darby Canine Kidney (MDCK) cell protein and MDCK cell DNA, along with polysorbate 80 and a few other ingredients.

Octoxynol-10 (TRITON X-100).  This is an ethoxylated alkyl phenol, and it’s found in some personal care products.  Speaking of which, according to the Skin Deep website from the Environmental Working group, this ingredient has a moderate overall hazard.

Thimerosal.  This is an ethyl mercury-based preservative used in vials that contain more than one dose of a vaccine to prevent germs, bacteria and/or fungi from contaminating the vaccine.  According to the CDC, while flu vaccines in multi-dose vials contain thimerosal to safeguard against contamination of the vial, most single-dose vials and pre-filled syringes of the flu shot do not contain a preservative because they are intended to be used only used once.  Material Safety Data Sheets (MSDS) are produced by companies that manufacture hazardous substances, and they provide information that includes the physical properties, toxicity, and reactivity of many different chemicals.  The MSDS says that thimerosal may be toxic to the kidneys, liver, spleen, bone marrow, and central nervous system, and that repeated or prolonged exposure to the substance can produce target organs damage.

Formaldehyde.  The MSDS lists formaldehyde as being very hazardous in case of eye contact or ingestion.  It also lists it as a probable human carcinogen.  This ingredient is also listed on the Skin Deep website, and its overall hazard is high, and the Environmental Working Group also lists it as being a high risk in cancer formation, along with organ system toxicity.  Some will argue that formaldehyde can be broken down when ingested, which is true, but it apparently can remain in its whole form when injected.             

β-propiolactone.  According to the MSDS, this is very hazardous in case of ingestion or inhalation, and is hazardous in case of skin contact or eye contact. 

Neomycin.  This is an antibiotic, and these are added to some inactivated influenza virus vaccines to prevent the growth of bacteria during production and storage of the vaccine.

Polysorbate 80.  This is a surfactant and emulsifier used in cleaners and personal care products.  The Environmental Working Group lists the overall hazard as low.  The MSDS lists it as being slightly hazardous in case of skin contact, of eye contact, of ingestion, or inhalation.  On the surface it doesn’t seem to be as bad of an ingredient when compared to the others, although apparently it is used by the pharmaceutical industry to help drugs get past the blood brain barrier, and there is a concern that it can also bind to some of the ingredients that are present in the vaccine.

Ovalbumin.  This is the main protein found in egg whites.  If someone has an egg allergy then getting a vaccine with this ingredient can be problematic, although if the ovalbumin concentration is low then those with egg allergies might be able to get it without a problem (3) [4].

Who Should Get The Flu Shot According To The CDC?

The CDC recommends for everyone six months and older to get the flu shot every year, although they emphasize that it is particularly important for people who are at high risk of serious complications if they were to get influenza.  According to their list this includes children younger than 5, adults 65 years of age and older, pregnant women, residents of nursing homes, and people with certain medical conditions including asthma, heart disease, diabetes mellitus, kidney disorders, liver disorders, a weakened immune system (i.e. HIV, cancer), and people with extreme obesity.

Who Should NOT Get The Flu Shot According To The CDC?

According to the CDC, the only two categories of people who should not get the flu shot include children younger than six months, and those people with severe, life-threatening allergies to the flu vaccine or any ingredient in the vaccine.  Of course sometimes the person doesn’t know if they have an allergy to certain ingredients.

Should People With Graves’ Disease and Hashimoto’s Receive The Flu Shot?

To answer this question we’ll take a look at what the research shows.  And while my focus is on thyroid autoimmunity, this information applies to those with any autoimmune condition.  Keep in mind that it can be difficult to make a direct link between vaccinations and autoimmunity, and correlation doesn’t always mean causation.  And while it’s probably safe to say that in most cases getting a vaccine won’t trigger an autoimmune response, numerous studies suggest that vaccines can occasionally stimulate autoantibody production, and in some cases the adjuvants in the vaccines can cause a condition known as autoimmune/inflammatory syndrome (4) [5] (5) [6] (6) [7].  Not all of these studies relate to the flu vaccine, although the last referenced study did discuss how “transiently or persistently increased levels of autoantibodies or the appearance of new autoantibodies was demonstrated in up to 15% of apparently healthy adults after the influenza vaccination”.

I also came across a journal review article which looked at autoimmune/inflammatory syndrome caused by vaccine adjuvants and the relationship between autoimmune thyroid conditions (7) [8].  Other than a few case reports there honestly isn’t a lot of evidence showing a direct link between vaccine adjuvants and autoimmunity, although the authors did conclude that physicians need to be aware that thyroiditis and other thyroid conditions can be induced by vaccine adjuvants, and therefore should reconsider non-essential vaccination (7) [8].  Plus, we also need to keep in mind that in autoimmune conditions it can take many years before someone presents with noticeable symptoms after receiving a vaccine, which is why it is difficult to prove a direct relationship.  This is especially true with Hashimoto’s Thyroiditis.  Of course earlier I mentioned that most flu vaccines don’t have adjuvants, although other ingredients such as thimerosal and formaldehyde are toxic.

Should YOU Receive The Flu Vaccine?

Whether or not you should personally get the flu vaccine is of course ultimately up to you.  As I mentioned in the opening paragraph, I personally have never received the flu shot.  And the reason for this is because I personally don’t think the benefits of getting the flu shot is greater than the potential risks.  I realize that in some cases it can be challenging to know if the benefits outweigh the risks.  For example, the CDC recommends for all pregnant women to get the flu shot, and while my wife didn’t receive the flu shot during either of her two pregnancies, many women choose to follow the advice of their medical doctor and get the flu shot during pregnancy.  I will add that the research shows that the influenza vaccine provides only moderate protection from influenza infection in pregnant women (8) [9], but to be honest, the main purpose of this blog post isn’t to convince you that the flu vaccine is ineffective.

The truth is that if someone has received the flu vaccine and they are exposed to the same strain that’s in the vaccine, there is a good chance that they won’t get the flu.  With that being said, the main reasons why I’m opposed to the flu vaccine is because 1) there are many other strains of influenza, and so it is very possible for someone to get the flu even after getting the vaccine, and 2) some of the ingredients included in the vaccine can be harmful.  Some healthcare practitioners also express concern about these chemicals being more harmful when injected.

This last point shouldn’t be taken lightly, as when talking about certain ingredients in vaccines such as mercury, some will argue that the amounts of these chemicals are so small that they won’t cause any harm.  But besides the fact that small amounts of some of these chemicals can potentially cause harm if ingested, they might even cause more harm when injected.  Finally, as I mentioned earlier, we can’t dismiss the potential synergistic effects of the chemicals included in the vaccine.

In summary, millions of people get the flu shot each year, and while at times the flu vaccine can reduce the risk of someone getting the flu virus, since there are many different strains of the flu overall the vaccine isn’t too effective.  In addition, one can’t dismiss the potentially harmful ingredients that are included in flu vaccines.  With regards to autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, while in most cases getting a vaccine won’t trigger an autoimmune response, this doesn’t mean that there aren’t any risks.  Studies do show that vaccines can occasionally lead to the production of autoantibodies.  And the concern isn’t just whether the flu virus can be an autoimmune trigger, as other health conditions are associated with some of the chemicals included in the vaccine.