Underactive thyroid

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Hello, I have a quick couple of questions on what I need to do as far as my medical cert. is concerned.
I just found out earlier this week that I have an underactive thyroid. Now the little bit of research I have done indicates this isn't really a major issue once I get the thyroid hormone dosage correct. My question is I am a student pilot and have gotten my 3rd class medical before having found out about this condition. Do I need to notify the FAA before I am due for my next physical? From looking at the FARs on aopa it looks like I just have to let them know at my next physical with documentation from my doctor showing that it is under control with no adverse side affects from the medication. Am I reading this correctly?
Thanks for any help that is forthcoming.
 
I believe you just have to notify them at your next physical, and you should probably get a letter from your doc before then saying that you are euthyroid (your thyroid levels are normal) with medication and you are suffering no secondary effects from the hypothyroidism.

BTW, don't sweat the disorder too much. It's very common, and all five of us in my family are hypothyroid. The trick is to get a doc that will work with you on dosage. The important thing is to not try to get your numbers right, but rather tailor the dose to where you *feel* better. The numbers will bounce around and are pretty sensitive, and there is argument even among endocrinologists what a "good" TSH number is. The current guidance is less than 3.3, but many people do not feel better (me included) until their TSH is less than 2.

Good luck!
 
Unregistered said:
I just found out earlier this week that I have an underactive thyroid. Now the little bit of research I have done indicates this isn't really a major issue once I get the thyroid hormone dosage correct. My question is I am a student pilot and have gotten my 3rd class medical before having found out about this condition. Do I need to notify the FAA before I am due for my next physical?
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No.
From looking at the FARs on aopa it looks like I just have to let them know at my next physical with documentation from my doctor showing that it is under control with no adverse side affects from the medication. Am I reading this correctly?
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That's not completely true, either. While it is true in terms of FAA notification, it does not cover the question of whether this constitutes a "medical deficiency" requiring you to ground yourself IAW 14 CFR 61.53(a) either because of the condition itself or the medication you are taking. Obtaining advice from an AME on that issue would be wise. I'm sure Bruce Chien will step in with information on that.
 
I have this condition (known as Hasimoto's Thyroiditis). It is treated with Cytomel and I make that clear each medical. I have a Class 2 and I'm good to go with the AME and the FAA.

Just make sure it's treated and you have evidence to support when you go to your AME.
 
bullwinkle said:
BTW, don't sweat the disorder too much. It's very common, and all five of us in my family are hypothyroid. The trick is to get a doc that will work with you on dosage. The important thing is to not try to get your numbers right, but rather tailor the dose to where you *feel* better. The numbers will bounce around and are pretty sensitive, and there is argument even among endocrinologists what a "good" TSH number is. The current guidance is less than 3.3, but many people do not feel better (me included) until their TSH is less than 2.
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Agree completely. I was essentially untreated for about a year (minimal doeses of sytntroid) until I found Dr. Roy Kerry in Greenvile, PA. He tests thyroid antibodies which is a key marker for thyroid problems.

Before Cytomel I could barely walk around the block without needing a nap (2 years earlier I was a Cat3 Bicycle racer riding 35-45 miles a day at 25 MPH+).

After Cytomel (adjusted dosage to my heart rate, basal temp, and general well being) I was able to resume a normal, active life.
 
It's an SI, relatively easy to obtain. Quoting from the FAA AMCD Form 5/02

Hypothyroidism Specifications:

Please provide your AME with a current status report from your treating physician regarding history of hypothyroidism. This report should include the information oulined below, along with a any separate additional testing. If the information provided is acceptable and your are found otherwiwse qualified, your AME may issue your medical certificate.

The current status report should include:

- Etiology of condition
- Name and dosage of thyroid replacement
- Other associated problems, such as cardiac or visual
- TSH level

The AME should defer to the Region or AMCD if:

- The airman develops a related problem in another system, such as cardiac
- The TSH level is elevated
 
Hashimoto's or Autoimmune thyroiditis is the condition that leads to hypothyroidism ("underactive thyroid"). According to current standard of care, every patient with hypothyroidism is tested for antibodies against the thyroid gland, anti-thyroglobulin and anti-peroxidase microsomal antibodies.

Cytomel and Syntroid are brand names of the thyroid hormone at different stages of biosynthesis. Cytomel is liothyronine and Synthroid is levothyroxine. Both are used to replace the thyroid hormone that the affected thyroid gland can't produce in enough amount.
 
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TeenDoc said:
Hashimoto's or Autoimmune thyroiditis is the condition that leads to hypothyroidism ("underactive thyroid"). According to current standard of care, every patient with hypothyroidism is tested for antibodies against the thyroid gland, anti-thyroglobulin and anti-peroxidase microsomal antibodies.

Cytomel and Syntroid are brand names of the thyroid hormone at different stages of biosynthesis. Cytomel is liothyronine and Synthroid is levothyroxine. Both are used to replace the thyroid hormone that the affected thyroid gland can't produce in enough amount.
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Interesting. I only ever remember being tested for T-3 levels until going to Dr Kerry.

I have had far better results with Cytomel than Synthroid.
 
TeenDoc said:
Hashimoto's or Autoimmune thyroiditis is the condition that leads to hypothyroidism ("underactive thyroid"). According to current standard of care, every patient with hypothyroidism is tested for antibodies against the thyroid gland, anti-thyroglobulin and anti-peroxidase microsomal antibodies.

Cytomel and Syntroid are brand names of the thyroid hormone at different stages of biosynthesis. Cytomel is liothyronine and Synthroid is levothyroxine. Both are used to replace the thyroid hormone that the affected thyroid gland can't produce in enough amount.
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Not exactly true. Hashimoto's is the most common cause, but there can be several different causes that are not autoimmune such as a pituitary tumor. If the antibodies are high though, it's definitely Hashimoto's.

Normal antibodies are <35ish...mine were over 400.
 
dmccormack said:
Interesting. I only ever remember being tested for T-3 levels until going to Dr Kerry.
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The most likely reason for the T3 level test was to see how much residual function your thyroid gland had. T3 accounts for about 20% of the circulating thyroid hormone, the other 80% is T4. When the thyroid gland starts to fail, it start to produce more T3 while the T4 fraction remains stable. In fact some patients with autoimmune thyroiditis, if caught early in the course, present with hyperthyroidism before becoming hypothyroid. The vast majority though are diagnosed after the acute thyroiditis phase due to their hypothyroidism. Some are even diagnosed by mere coincidence. For example, many patients with depression, anxiety and other psych conditions have thyroid test done routinely, same with both types of diabetes I & II. In the case of diabetes there is an statistical association between diabetes and thyroiditis. Every diabetic should have the thyroid function tested.

dmccormack said:
I have had far better results with Cytomel than Synthroid.
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You are not the only one. There is a lot of biologic variability treating thyroid disorders and there is also tremendous variability in the bioavailability of the thyroid hormone present in different pharmaceutical preparations. Some endocrinologist, for example would never prescribe the generic form of L-thyroxine, only Synthroid. I'm in the second category, as a physician and patient.
 
bullwinkle said:
Not exactly true. Hashimoto's is the most common cause, but there can be several different causes that are not autoimmune such as a pituitary tumor.
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In this case, we are talking of secondary hypothyroidism. The primary problem is the tumor in the pituitary and, depending on the location within the pituitary, the size and whether the tumor is of hormone producing versus non-producing cells, you may have other glands downstream from the pituitary affected. But that is not primary hypothyroidism.
 
TeenDoc said:
You are not the only one. There is a lot of biologic variability treating thyroid disorders and there is also tremendous variability in the bioavailability of the thyroid hormone present in different pharmaceutical preparations. Some endocrinologist, for example would never prescribe the generic form of L-thyroxine, only Synthroid. I'm in the second category, as a physician and patient.
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I don't remember if the "Synthroid" was generic or not -- I had a near overnight improvement after starting the Cytomel regimen and will not go back.
 
Ron Levy said:
That said, is this a 61.53-grounding condition or medication until an SI is obtained?
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I wouldn't call hypothryroidisn a special issuance condition. It is more like hypertension. An appropriate letter from the treating physician and a TSH level on the first presentation and the AME can issue a medical without an SI. As far as self grounding, it depends on symptoms. Many people with hypothryroidism are so easily fatigued they get tired thinking about towing out the airplane. Do they pass the IM SAFE check. If not, ground. During the first week of therapy, it wouldn't hurt to self ground just because any new medication can have unexpected side effects. I don't recall any mandatory length of time to self ground.

Barb
 
TeenDoc said:
It's an SI, ...
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Apparently not always. I've reported Hashimoto's for every medical since 1995 and I've never had an SI for it. Even when my medical was deferred to OK three years ago for another condition the FAA didn't require an SI.
 
Barb...an SI "IS" required to fly with hypothyroidism.
http://flightphysical.com/AASI/AASI-Hypothyroidism.htm

One Short said:
I wouldn't call hypothryroidisn a special issuance condition. It is more like hypertension. An appropriate letter from the treating physician and a TSH level on the first presentation and the AME can issue a medical without an SI. As far as self grounding, it depends on symptoms. Many people with hypothryroidism are so easily fatigued they get tired thinking about towing out the airplane. Do they pass the IM SAFE check. If not, ground. During the first week of therapy, it wouldn't hurt to self ground just because any new medication can have unexpected side effects. I don't recall any mandatory length of time to self ground.

Barb
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The way AMCD is handling this matter now has softened. I was issued and SI for Autoimmune Thyroiditis manifested by hypothyroidism stable on medication. I've had my 6-year letter issued twice and my AME can issue locally but my TSH results go to OK and about a month later I get a letter with the usual blah blah blah, etc.
 
True...it has softened and OKC wants to get you in the air...

TeenDoc said:
The way AMCD is handling this matter now has softened. I was issued and SI for Autoimmune Thyroiditis manifested by hypothyroidism stable on medication. I've had my 6-year letter issued twice and my AME can issue locally but my TSH results go to OK and about a month later I get a letter with the usual blah blah blah, etc.
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Kelvin said:
True...it has softened and OKC wants to get you in the air...
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I was at a FAASTeam seminar a couple of months ago where they said that fewer than 0.5% of medicals are actually denied. So yes, it's fair to say that OKC wants to get you in the air.
 
One Short said:
I wouldn't call hypothryroidisn a special issuance condition. It is more like hypertension. An appropriate letter from the treating physician and a TSH level on the first presentation and the AME can issue a medical without an SI. As far as self grounding, it depends on symptoms. Many people with hypothryroidism are so easily fatigued they get tired thinking about towing out the airplane. Do they pass the IM SAFE check. If not, ground. During the first week of therapy, it wouldn't hurt to self ground just because any new medication can have unexpected side effects. I don't recall any mandatory length of time to self ground.

Barb
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I can't believe I missed this one. Hypothyroidism is in fact an SI. Hypothyroidism IS disqualifying and that is detailed in the 2008 AME guide.

That having been said, many AMEs have just issued based on normalized TSH values. I find this when my colleage AME goes out of town (to Mosul, he's an O-6 and his guys end up in my place). However the Current Federal Air surgeon has sent down from on high that these HAVE to be SI'd, they want ONE YEAR followup on thyroid replacment and almost always issue the 6-years AASI.

So currently page 227 and 134 are in conflict in the AME guide. The AME is NOT wrong to just issue on 60 day stability with a normal TSH per page 134. But CAMI is definitely NOT wanting the extra work of issuing one year SIs to all the midlife hypothyroid failures out there.....so they have let the self contradictory AME guide 2008 stand.

If an AME calls FAA and gets Dr. C, you will be given an SI. If you call Dr. M., you will get a "go ahead and issue....for a year ". So I have compromised by going ahead and issuing for a year, on 60 day's stability, normal TSH at the end of 60 days, and sending the AASI coversheet in on which I have typed the page 134 instruction.

You should self ground until you have a normal TSH.
 
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Bruce,

Where were you man? :frown3:

I paged you, called your service... :nono::nono:

Flying ummm! :D:D:D

Thanks for clarifying.
 
gprellwitz said:
I was at a FAASTeam seminar a couple of months ago where they said that fewer than 0.5% of medicals are actually denied. So yes, it's fair to say that OKC wants to get you in the air.
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OK, but how to "fudge" with statistics: If an applicant gets a deferral letter asking for $15,000 in tests, it's not a denial. :rolleyes:
 
But if he doesn't submit them in 60 days, it becomes a "denial for lack of information".
 
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