My Flight Surgeon
Sr. Aviation Medical Examiner
This is another in the series of condition for which the FAA grants Special Issuance certificates.
As with all other conditions, the FAA will want to review the entire medical record. Your AME or Home can assist you in preparing your records for submission.
The topic today is Hypothyroidism.
Hypothyroidism is a condition in which the body lacks sufficient thyroid hormone. Since the main purpose of thyroid hormone is to "run the body's metabolism", it is understandable that people with this condition will have symptoms associated with a slow metabolism. Over five million Americans have this common medical condition. In fact, as many as ten percent of women may have some degree of thyroid hormone deficiency. Hypothyroidism is more common than you would believe...and, millions of people are currently hypothyroid and don't know it!
There are two fairly common causes of hypothyroidism. The first is a result of previous(or currently ongoing) inflammation of the thyroid gland which leaves a large percentage of the cells of the thyroid damaged (or dead) and incapable of producing sufficient hormone. The most common cause of thyroid gland failure is called autoimmune thyroiditis (also called Hashimoto’s thyroiditis), a form of thyroid inflammation caused by the patient's own immune system. The second major cause is the broad category of "medical treatments".the treatment of many thyroid conditions warrants surgical removal of a portion or all of the thyroid gland. If the total mass of thyroid producing cells left within the body are not enough to meet the needs of the body, the patient will develop hypothyroidism. Remember, this is often the goal of the surgery as seen in surgery for thyroid cancer. But at other times, the surgery will be to remove a worrisome nodule, leaving half of the thyroid in the neck undisturbed. Sometimes (often), this remaining thyroid lobe and isthmus will produce enough hormone to meet the demands of the body. For other patients, however, it may become apparent years later that the remaining thyroid just can't quite keep up with demand. Similarly, goiters and some other thyroid conditions can be treated with radioactive iodine therapy. The aim of the radioactive iodine therapy (for benign conditions) is to kill a portion of the thyroid to 1) prevent goiters from growing larger, or 2) producing too much hormone (hyperthyroidism). Occasionally, the result of radioactive iodine treatment will be that too many cells are damaged so the patient often becomes hypothyroid a year or two later. This is O.K. and usually greatly preferred over the original problem. There are several other rare causes of hypothyroidism, one of them being a completely "normal" thyroid gland which is not making enough hormone because of a problem in the pituitary gland. If the pituitary does not produce enough Thyroid Stimulating Hormone (TSH) then the thyroid simply does not have the "signal" to make hormone, so it doesn't.
Symptoms of Hypothyroidism
Fatigue
Weakness
Weight gain or increased difficulty losing weight
Coarse, dry hair
Dry, rough pale skin
Hair loss
Cold intolerance (can't tolerate the cold like those around you)
Muscle cramps and frequent muscle aches
Constipation
Depression
Irritability
Memory loss
Abnormal menstrual cycles
Decreased libido
Potential Dangers of Hypothyroidism
Because the body is expecting a certain amount of thyroid hormone the pituitary will make additional thyroid-stimulating-hormone (TSH) in an attempt to entice the thyroid to produce more hormone. This constant bombardment with high levels of TSH may cause the thyroid gland to become enlarged and form a goiter (termed a "compensatory goiter"). Left untreated, the symptoms of hypothyroidism will usually progress. Rarely, complications can result in severe life-threatening depression, heart failure or coma.
Hypothyroidism can often be diagnosed with a simple blood test.In some persons, however, its not so simple and more detailed tests are needed. Most importantly, a good relationship with a good endocrinologist will almost surely be needed.
Hypothyroidism is completely treatable in many patients simply by taking a small pill once a day! Once again, however, we have made a simplified statement and its not always so easy. There are several types of thyroid hormone preparations and one type of medicine will not be the best therapy for all patients. Many factors will go into the treatment of hypothyroidism and it is different for everybody.
Since hypothyroidism is caused by too little thyroid hormone secreted by the thyroid, the diagnosis of hypothyroidism is based almost exclusively upon measuring the amount of thyroid hormone in the blood. There are normal ranges for all thyroid hormones which have been calculated by computers which measured these hormones in tens of thousands of people. If your thyroid hormone levels fall below the normal range, that is consistent with hypothyroidism. These tests are very accurate and reliable and are so routine that they are available to everybody.
Treatment of Hypothyroidism
Hypothyroidism is usually quite easy to treat! The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day, preferably in the morning. This medication is a pure synthetic form of T4 which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established. The dose should then be re-evaluated at least annually. If you are on this medication, make sure your physician knows it so he/she can check the levels at least yearly. After about one month of treatment, hormone levels are measured in the blood to establish whether the dose of thyroid hormone which the patient is taking is appropriate. We don't want too much given or subtle symptoms of hyperthyroidism could ensue, and too little would not alleviate the symptoms completely. Often blood samples are also checked to see if there are antibodies against the thyroid, a sign of autoimmune thyroiditis. Remember, this is the most common cause of hypothyroidism. Once treatment for hypothyroidism has been started, it typically will continue for the patient's life. Therefore, it is of great importance that the diagnosis be firmly established and you have a good relationship with a physician you like and trust.
FAA Special Issuance
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or Regional Flight Surgeon for the initial determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
As with all other conditions, the FAA will want to review the entire medical record. Your AME or Home can assist you in preparing your records for submission.
The topic today is Hypothyroidism.
Hypothyroidism is a condition in which the body lacks sufficient thyroid hormone. Since the main purpose of thyroid hormone is to "run the body's metabolism", it is understandable that people with this condition will have symptoms associated with a slow metabolism. Over five million Americans have this common medical condition. In fact, as many as ten percent of women may have some degree of thyroid hormone deficiency. Hypothyroidism is more common than you would believe...and, millions of people are currently hypothyroid and don't know it!
There are two fairly common causes of hypothyroidism. The first is a result of previous(or currently ongoing) inflammation of the thyroid gland which leaves a large percentage of the cells of the thyroid damaged (or dead) and incapable of producing sufficient hormone. The most common cause of thyroid gland failure is called autoimmune thyroiditis (also called Hashimoto’s thyroiditis), a form of thyroid inflammation caused by the patient's own immune system. The second major cause is the broad category of "medical treatments".the treatment of many thyroid conditions warrants surgical removal of a portion or all of the thyroid gland. If the total mass of thyroid producing cells left within the body are not enough to meet the needs of the body, the patient will develop hypothyroidism. Remember, this is often the goal of the surgery as seen in surgery for thyroid cancer. But at other times, the surgery will be to remove a worrisome nodule, leaving half of the thyroid in the neck undisturbed. Sometimes (often), this remaining thyroid lobe and isthmus will produce enough hormone to meet the demands of the body. For other patients, however, it may become apparent years later that the remaining thyroid just can't quite keep up with demand. Similarly, goiters and some other thyroid conditions can be treated with radioactive iodine therapy. The aim of the radioactive iodine therapy (for benign conditions) is to kill a portion of the thyroid to 1) prevent goiters from growing larger, or 2) producing too much hormone (hyperthyroidism). Occasionally, the result of radioactive iodine treatment will be that too many cells are damaged so the patient often becomes hypothyroid a year or two later. This is O.K. and usually greatly preferred over the original problem. There are several other rare causes of hypothyroidism, one of them being a completely "normal" thyroid gland which is not making enough hormone because of a problem in the pituitary gland. If the pituitary does not produce enough Thyroid Stimulating Hormone (TSH) then the thyroid simply does not have the "signal" to make hormone, so it doesn't.
Symptoms of Hypothyroidism
Potential Dangers of Hypothyroidism
Because the body is expecting a certain amount of thyroid hormone the pituitary will make additional thyroid-stimulating-hormone (TSH) in an attempt to entice the thyroid to produce more hormone. This constant bombardment with high levels of TSH may cause the thyroid gland to become enlarged and form a goiter (termed a "compensatory goiter"). Left untreated, the symptoms of hypothyroidism will usually progress. Rarely, complications can result in severe life-threatening depression, heart failure or coma.
Hypothyroidism can often be diagnosed with a simple blood test.In some persons, however, its not so simple and more detailed tests are needed. Most importantly, a good relationship with a good endocrinologist will almost surely be needed.
Hypothyroidism is completely treatable in many patients simply by taking a small pill once a day! Once again, however, we have made a simplified statement and its not always so easy. There are several types of thyroid hormone preparations and one type of medicine will not be the best therapy for all patients. Many factors will go into the treatment of hypothyroidism and it is different for everybody.
Since hypothyroidism is caused by too little thyroid hormone secreted by the thyroid, the diagnosis of hypothyroidism is based almost exclusively upon measuring the amount of thyroid hormone in the blood. There are normal ranges for all thyroid hormones which have been calculated by computers which measured these hormones in tens of thousands of people. If your thyroid hormone levels fall below the normal range, that is consistent with hypothyroidism. These tests are very accurate and reliable and are so routine that they are available to everybody.
Treatment of Hypothyroidism
Hypothyroidism is usually quite easy to treat! The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day, preferably in the morning. This medication is a pure synthetic form of T4 which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established. The dose should then be re-evaluated at least annually. If you are on this medication, make sure your physician knows it so he/she can check the levels at least yearly. After about one month of treatment, hormone levels are measured in the blood to establish whether the dose of thyroid hormone which the patient is taking is appropriate. We don't want too much given or subtle symptoms of hyperthyroidism could ensue, and too little would not alleviate the symptoms completely. Often blood samples are also checked to see if there are antibodies against the thyroid, a sign of autoimmune thyroiditis. Remember, this is the most common cause of hypothyroidism. Once treatment for hypothyroidism has been started, it typically will continue for the patient's life. Therefore, it is of great importance that the diagnosis be firmly established and you have a good relationship with a physician you like and trust.
FAA Special Issuance
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or Regional Flight Surgeon for the initial determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
- An Authorization granted by the FAA;
- The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects;
- A statement regarding any other associated problems, such as cardiac or visual; and
- A statement regarding the current thyroid stimulating hormone (TSH) level performed within last 90 days.
- The applicant develops a related problem in another system, such as cardiac; or
- The TSH level is elevated.
