Thyroid treatment post thyroid cancer

[rivets]

Hi folks,

I have another medical issue. I was diagnosed and treated for thyroid cancer in 2012. All scans clear so no remaining tumor (thankful for that!) but I am now euthryroid (don't have a thyroid gland) and so need thyroid hormone replacement.

I see lots of posts about hypothyroidism. Duly noted, thanks.

The thing that makes post-thyroid cancer treatment different is that we are, as a matter of standard protocol, deliberately given a higher than usual dose of hormone, so that our TSH (thyroid stimulating hormone) level goes down. This is like sort of sending a "down, boy!" signal to any possible lingering thyroid cells in case they too are cancerous.

Overdose of thyroid hormone causes thyrotoxicosis, which can have effects on mood and the heart.

A nice writeup is given here --

http://www.faa.gov/other_visit/avia...signee_types/ame/fasmb/media/201004_color.pdf

In order to keep my TSH low, endocrinologists often have to adjust the dosage of thyroid hormone. In all cases, though, at least for low-risk patients like me, the target TSH is in the normal range (if on the extreme low end of it).

Question -> Will the FAA certify if the endocrinologist simply reports, "thyroid hormone is currently being adjusted to keep TSH low, but TSH is now and will be kept in the normal range"? Or must the patient have a 100% stable thyroid hormone dosage and TSH before being certified?

Thanks!!

Rivets

 

[bbchien]

They wish to see a TSH in the normal range.

All that is needed to suppress for post thyroid malignancy is a low normal range. Get a Free T4 index to show that you are not substantially over-replaced.

 

[rivets]

Thanks Bruce (and hello again!).

Do they need to see a *stable* level (i.e., a level + a promise that it is unlikely to change)? Or do they just need to see *some* level?

Note the problem here is that there are adjustments ongoing. Do I have to wait till all the adjustments are complete?

 

[bbchien]

The doc has to testify that it is stable, or the numbers over 90 days, have to show same.

 

[rivets]

Got it -- thanks!

While adjusting TSH over the next few months, will my SSRI psych stuff (CogScreen-AE, reports, ...) "expire" and have to be re-done?

 

[bbchien]

No the psych stuff, but if I knew you had this other situation, I would have recommended that you waited on the Cogscreen and assoc. panels. Thyrotoxicosis shows abnormal on these panels......

You are a classic example of "....and oh by the way...." which kills a LOT of medicals. These two conditions interact greatly. Progressive/selective revealation is a very very bad strategy where fitness is concerned.

 

[rivets]

Cool thanks --- good to know!

As for thyrotoxicosis changing the psych stuff, I suspect it did not/will not in my specific case.

As for a certification consultant -- and I hope this information is useful to other folks here -- isn't that simply supposed to be your very own dearly beloved AME? Isn't that their job, to collect and correlate everything and advocate in your favor to the FAA?

Rivets

 

[bbchien]

No. Their job is to do an exam and inform FAA of the issues.

I have no idea what your thinking is that the two are not related, I just got a guy certified but he had to test (psychometrics) twice ($$s) as he tested too early after control of his thyrotoxicosis. YMMV.

So I hope things work out for you - but you now have a wild card as part of your metrics are already done.....

 

[rivets]

Wow that's bad news. Oh well.

The good news is that I'm perfectly healthy and from what you say and have said, I should have no problem certifying.

Rivets

 

[Blatham489]

Thyroid cancer and full thyroidectomy with hormones under control is a no brainer, some paperwork, but easy to handle.

 

[rivets]

Thanks for the encouragement, Mule Renter! I guess the part about having the hormones under control is going to take some time. Wish me luck!

Rivets

 

[MooneyDriver78]

Thyroid cancer and full thyroidectomy with hormones under control is a no brainer, some paperwork, but easy to handle.

In my case it's hard to get it in the sweet spot, I've change prescriptions 4 times in past 2 years, finally my Doc said its close enough, and I like it where it's at...
The first time they gave me a provisional? (1 year), this time I got the full 2 years.

 

[rivets]

The first time they gave me a provisional? (1 year), this time I got the full 2 years.

Ok so you're saying your level was not "stable" and they gave you a provisional while you stabilized it? Would you mind sharing (non-identifying, of course!) details of what exactly your situation was and what you had your doctor say to the FAA? That would be infinitely useful to me....

Kind regards,

Rivets