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鈥檚 thyroiditis.
Please tell me if that鈥檚 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.
Hashimoto鈥檚 thyroiditis is a condition where the body鈥檚 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鈥檛 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-Barr茅 syndrome within six weeks of a previous influenza vaccine generally are not vaccinated again. Hashimoto鈥檚 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鈥檛 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 鈥� say, 175/80 鈥� in what circumstances would you suggest not taking any hypertensive drugs to lower pressure (to 130/80 or less)? Aren鈥檛 there some fragile people who require higher blood pressure to meet the body鈥檚 demands?
R.I.
It used to be the case that older people with high blood pressure were not treated. In fact, the term 鈥渆ssential hypertension鈥� (which now means 鈥渉igh blood pressure with no identifiable cause鈥�) 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 鈥� such as a diastolic (that鈥檚 the second number) pressure over 110 鈥� the blood flow to the brain might 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.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
