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Hashimotos is no excuse for avoiding the flu shot
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DEAR DR. ROACH: I have never gotten the flu vaccine. Years ago, it was believed to be too dangerous for anyone with an autoimmune condition. They said that the body could not handle the vaccine and that it was actually dangerous to receive it. I have Hashimoto’s thyroiditis.

   I value your knowledge and opinion. Please tell me if that’s true. I had the flu in 1993 and have not been ill with anything but a cold since. I was not hospitalized in 1993. -- I.D.C.

ANSWER: Hashimoto’s thyroiditis is a condition where the body’s immune system attacks the thyroid gland, in the neck. The thyroid level initially increases in the body, but then over time, it decreases. In most, it eventually will come back to normal, but people require treatment with thyroid hormone, often for years.

I don’t agree with the advice you received about the flu vaccine. The clearest reason not to give a flu vaccine (I mean specifically the flu shot, which does not contain live virus) is if people have a severe allergy to any of the components of the vaccine. People who have had Guillain-Barre syndrome within six weeks of a previous influenza vaccine generally are not vaccinated again. Hashimoto’s is not a reason to avoid the flu shot.

2017-2018 has been a severe season for influenza, and while I am glad you haven’t had the flu in many years, I still recommend the vaccine every year. It provides protection, even if incomplete, for a disease that kills up to 50,000 people per year. People who are vaccinated also help protect those people who are unable to be vaccinated.

   DEAR DR. ROACH: If a person who is 75 or older has high blood pressure -- say, 175/80 -- in what circumstances would you suggest not taking any hypertensive drugs to lower pressure (to 130/80 or less)? Aren’t there some fragile people who require higher blood pressure to meet the body’s demands? -- R.I.

   ANSWER: It used to be the case that older people with high blood pressure were not treated. In fact, the term “essential hypertension” (which now means “high blood pressure with no identifiable cause”) initially was used to indicate that high blood pressure was essential for adequate blood flow. However, study after study has shown that older people with systolic blood pressure above 160 can have a dramatic reduction in the risk of stroke with treatment. 

   It certainly is true that the blood pressure should be brought down slowly and judiciously. By using low doses of medication at first, we can reduce the symptoms of having too low a blood pressure. In people whose blood pressure is chronically very high -- such as a diastolic (that’s the second number) pressure over 110 -- the blood flow to the brain may no longer be regulated properly, so the blood pressure is brought down very slowly indeed.

   There have been many situations where what was thought to be common wisdom was upended by the results of carefully done, large clinical trials. How a large-scale trial applies to a given individual is not always obvious, and it still requires a skilled clinician with knowledge of both the individual patient and an understanding of the biology of the condition. It would be a very unusual situation for me not to recommend treating a blood pressure that high.