Thyroid Problems (Hypothyroidism)

[Guest weis5on]

Doc,

I have Hashimotos disease (hope I spelled that one right) and I am about to send applications out for UPT slots in reserve units. The condition has been treated for quite some time now, so my question is can a waiver be issued for non-rated individuals prior to entering UPT? Also, should I disclose this info immediately or wait until I get a slot? Does the Air Force even have to know about this condition?

Thank you in advance,

weis5on

[Guest Flight Doc]

You disclose it during your FC I. And yes, you must. It's a felony to "forget" to disclose significant medical issues.

Properly treated hypothyroidism is commonly waived.

From the waiver guide:

I. Overview. Hashimoto?s thyroiditis and thyroid ablative therapy are the most common causes of hypothyroidism. Other causes include neck irradiation, medications and hypothalamic or pituitary deficiency. Onset of symptoms is often insidious; subclinical hypothyroidism is much more common than full-blown myxedema. Symptoms include fatigue, lethargy, physical and mental slowness, apathy, headache, cold-intolerance, arthralgias, myalgias, thick dry skin, hoarse voice, and constipation. Diagnosis is often delayed because of the apathy, which causes patients to minimize complaints. Like hyperthyroidism, a single symptom may dominate the clinical picture. In rapid onset hypothyroidism, myalgias, arthralgias, and paresthesias are often the major symptoms. Other than drug-induced, hypothyroidism is generally progressive and irreversible.

Diagnosis: Laboratory diagnosis is made by determining the TSH and T4 levels. An elevated TSH and low T4 confirm the diagnosis. Serum T3 and RT3U are not helpful in diagnosing hypothyroidism; both are normal in up to 50% of hypothyroid patients.

Therapy: Thyroxine (Synthroid) is used to produce euthyroidism. A normal serum TSH level verifies full thyroid replacement. Patients must be followed on a regular basis indefinitely. A lapse in therapy could result in recurrence of apathy and loss to follow up.

II. Aeromedical Concerns. The major aeromedical concern is the insidious nature of the disease, which could delay diagnosis until apathy, fatigue, and mental slowness lead to significant performance decrement. This same concern applies during follow-up of treated hypothyroid patients.

III. Information Required for Waiver Submission. Initial waiver requires endocrine consultation and confirmation of euthyroid status. Annual renewal requires confirmation of euthyroid status.

IV. Waiver Considerations. Almost all flyers with hypothyroidism have been successful in obtaining a waiver to return to flying. Those who were not were disqualified for incomplete or unsuccessful treatment or for other unrelated diagnoses. As of 3/97 169 rated officers had received waivers for treated hypothyroidism.

[Guest jshedron]

I am hypothyroid, but am clinically euthyroid with daily dose of synthroid. I am otherwise fit. Do you think that my waiver will be approved?

[Guest F16PilotMD]

The USAF Waiver Guide indicates that nearlly all rated personnel have been granted waivers provided they are euthyroid with treatment. I can't find anything to tell me the stats for applicants. I just don't know what your chances are. They are much more forgiving after investing $1M+ to train you....for applicants, I just don't know the answer. I would be willing to submit the waiver, give it a shot.

===========================

WAIVER GUIDE:

CONDITION: HYPOTHYROIDISM

I. Overview. Hashimoto’s thyroiditis and thyroid ablative therapy are the most common causes of hypothyroidism. Other causes include neck irradiation, medications and hypothalamic or pituitary deficiency. Onset of symptoms is often insidious; subclinical hypothyroidism is much more common than full-blown myxedema. Symptoms include fatigue, lethargy, physical and mental slowness, apathy, headache, cold-intolerance, arthralgias, myalgias, thick dry skin, hoarse voice, and constipation. Diagnosis is often delayed because of the apathy, which causes patients to minimize complaints. Like hyperthyroidism, a single symptom may dominate the clinical picture. In rapid onset hypothyroidism, myalgias, arthralgias, and paresthesias are often the major symptoms. Other than drug-induced, hypothyroidism is generally progressive and irreversible.

Diagnosis: Laboratory diagnosis is made by determining the TSH and T4 levels. An elevated TSH and low T4 confirm the diagnosis. Serum T3 and RT3U are not helpful in diagnosing hypothyroidism; both are normal in up to 50% of hypothyroid patients.

Therapy: Thyroxine (Synthroid) is used to produce euthyroidism. A normal serum TSH level verifies full thyroid replacement. Patients must be followed on a regular basis indefinitely. A lapse in therapy could result in recurrence of apathy and loss to follow up.

II. Aeromedical Concerns. The major aeromedical concern is the insidious nature of the disease, which could delay diagnosis until apathy, fatigue, and mental slowness lead to significant performance decrement. This same concern applies during follow-up of treated hypothyroid patients.

III. Information Required for Waiver Submission. Initial waiver requires endocrine consultation and confirmation of euthyroid status. Annual renewal requires confirmation of euthyroid status.

IV. Waiver Considerations. Almost all flyers with hypothyroidism have been successful in obtaining a waiver to return to flying. Those who were not were disqualified for incomplete or unsuccessful treatment or for other unrelated diagnoses. As of 3/97 169 rated officers had received waivers for treated hypothyroidism.

[Guest KC10IPTravis]

Doc,

I have a family history of thyroid problems, and have notice some of the "symptoms" that they experienced lately... sluggishness, unexplained weight gain without being able to take it off with diet and exercise, etc. Are there any other ways to tell if I am getting the family "disease".. ha ha. Also, if I am hypo, what is the AF take on it for a pilot?? Tests, medications, waivers, etc? Thanks

Scott

[Guest F16PilotMD]

You need a simple blood test for "TSH" level (Thyroid Stimulating Hormone". If it's low, you may be hypothyroid. The USAF will likely give you a waiver for taking a drug to correct this called Synthroid.

[Guest AirGuardian]

I hear the 40 year old mark has something to do with sluggishness, unexplained weight gain and excercising to no avail - but that's talking and watching the the higher up guys gain innertube bumper bellies. Probably has something to do with flying the LGD-6D more often than MWS's...

LGD-6D = Large Grad Desk with 6 Drawers! I'm not the "Man" like F16PilotMD is, so you had better listen to him!

[Guest dumaisj]

As a search gave me nothing, I'll post it. I was diagnosed with hyperthyroidism that cleared on its own without medication in one month. I am now euthyroid and have been so for quite some time. Is this history disqualifying? As I read AFI48-123, Attachment 7, it mentions hyperthyroidism as disqualifying, but says nothing about a history of it. This leads me to the conclusion that it would need to be a current condition at the time of examination. Am I correct, or did I misread? I will be normal by blood test, so do I even need to worry about a waiver? I'm not sure I interpreted all the AFI nuances correctly, so I may be mistaken. F16PilotMD, can you clear this up?

[ 24. November 2004, 13:53: Message edited by: dumaisj ]

[Guest F16PilotMD]

I'm TDY and without my "book of knowedge". I'll have to get back to you later. But, give me some specifics here...

How/why were you diagnosed? You generally can't be temporarily hyperthyroid unless you have an inflammatory condition/infection/etc. I'm confused.

Second, were your thyroid function tests elevated? Are they now nomal? Over what period of time did this occur?

Let me know about this stuff and I'll look it up when i get hiome.

[Guest F16PilotMD]

The only thing I can find is the "hyperthyroidism" is DQ. DON'T PANIC. This would be someone who is currently hyperthyroid. It is always treatable and waiverable for FC2 (i.e.: already pilots/navs). The problem is always what to do with IFC-1. Typically, if the reg doesn't say "not waiverable for Flying Class 1", it IS waiverable for IFC-1. Again, this is for folks who are currently hyperthyroid.

Your case is ?????????. Hyperthyroidism doesn't just get better. With no other details about your case, and if you admit to this in your medical history, my guess is you would be sent for an Endocrinology consultation and cleared. This may result in an initial DQ and require waiver.

[Guest dumaisj]

Sorry Doc, I was out of town interviewing with the A-10 unit in PA. I have spoken with a few flight surgeons during the interim to see if they could confirm my reading of AFI48-123. Evidently, as I am currently euthyroid, I will be fine for the IFC1. Without boring you with every single detail, I was on PTU for a month and have consistantly tested normal since. The original hyperthyroid diagnosis was 1/04 and I was back to normal by 2/04. I had a full metabolic workup again in 10/04 and my endocrinologist verified that I was fine. Like I said, the other flight docs I've spoken with have said I am good to go. Is this correct? I was planning on reporting it at the physical as I am non-prior (no military record of it) and I will pass all the bloodwork tests. I'm not worried...should I be? Thanks for the help!

[Guest F16PilotMD]

I see no reason to worry. It would not surprise me if AETC/SG disqualifies you for this history...or simply requests a full endocrinology evaluation and report (some of which you may have done already to their satisfaction). They have to be convinced that you are not a medical/financial risk to the USAF and that you are not a flight medical risk. This flight part is pretty easy...NO. The long-term health risks are more questionable. Why did you get this? Will it occur again? Is it easily treatable? Etc, etc.

Hard to predict if it will come to this or not. In either case, I feel pretty confident you will be okay for IFC-1...waiver or not.

[Guest dumaisj]

Doc, thanks for taking the time to reserach it a bit. I appreciate the help and I'll let you know how things go.

[Guest F16crewdwgg]

The only thing I can find is the "hyperthyroidism" is DQ. DON'T PANIC. This would be someone who is currently hyperthyroid. It is always treatable and waiverable for FC2 (i.e.: already pilots/navs). The problem is always what to do with IFC-1. Typically, if the reg doesn't say "not waiverable for Flying Class 1", it IS waiverable for IFC-1. Again, this is for folks who are currently hyperthyroid.

So, I didn't fully understand this. If you have hyperthyroidism and its under control with medication it will be waivered? I may have it, waiting on test results to come back. My TSH (I believe thats what its called) had a low count, so my doc wanted me to get rechecked with a few other tests.

If you or someone else can help me understand this that'd be great. I looked everywhere on google and I can't find anything on Hyperthyroidism and DQ for the Air Force. Thanks guys, I appreciate it.

[Flare]

I don't know anything about this guy's condition...but I do know that he graduated from ENJJPT a few months ago and is in IFF now, so he obviously got it worked out. Shoot him a PM.

[Guest F16crewdwgg]

I don't know anything about this guy's condition...but I do know that he graduated from ENJJPT a few months ago and is in IFF now, so he obviously got it worked out. Shoot him a PM.

Well he said his hyperthyroidism went away.. so I was trying to do a follow up on what F16PilotMD was trying to say about people who had hyperthyroidism. I didn't fully understand if he was saying it was waiverable or not.

[Guest P27:17]

So, I didn't fully understand this. If you have hyperthyroidism and its under control with medication it will be waivered? I may have it, waiting on test results to come back. My TSH (I believe thats what its called) had a low count, so my doc wanted me to get rechecked with a few other tests.

If you or someone else can help me understand this that'd be great. I looked everywhere on google and I can't find anything on Hyperthyroidism and DQ for the Air Force. Thanks guys, I appreciate it.

The simple answer is: if you have hypothyroidism controlled with synthroid (there may be other meds) you can get a waiver if it is under control and there are no other issues related to it.

I don't have AFI 48-123 at my house but if you can get into it, look in volume three under Flying and then go to the Endocrine section...you'll see it about a third of the way down the page...

[Guest awfltdoc]

Per USAF Waiver Guide Feb. 2007:

Hyperthyroidism is waiverable. This condition has several different causes and a waiver will not likely by given as long as the aviator is actively hyperthyroid. If the condition is treated and the aviator becomes euthyroid by treatment (hormone replacement) then a waiver can be considered.

Treatments depend on the condition but Radioactive Iodine ablation, surgery, or thioureas (off of this for at least three years for FCI/IA) can be considered for waiver. For FCII or FCIII; must be off thioureas for six months.

Edited November 20, 2007 by awfltdoc

[Guest F16crewdwgg]

Per USAF Waiver Guide Feb. 2007:

Hyperthyroidism is waiverable. This condition has several different causes and a waiver will not likely by given as long as the aviator is actively hyperthyroid. If the condition is treated and the aviator becomes euthyroid by treatment (hormone replacement) then a waiver can be considered.

Treatments depend on the condition but Radioactive Iodine ablation, surgery, or thioureas (off of this for at least three years for FCI/IA) can be considered for waiver. For FCII or FCIII; must be off thioureas for six months.

So just wondering. I actually went back to my doc, and she told me my thyroid count is now fine and that my T3 and T4 was also in good condition and my TSH was probably low because of being sick.. When I get my physical do they check your TSH anyway? or is it only something they check if you previously tell them you had a case. I mean if i get checked again just to be sure and it comes back fine.. and it was indeed just because i was sick... Is this something that needs to be mentioned at the physical. The way im interpreting this, is I never really had Hyperthyroidism from the get. It was just normal for my tsh to go down from being sick. So therefore I never had nothing more but a bad cold. Any suggestions?

[Guest awfltdoc]

So just wondering. I actually went back to my doc, and she told me my thyroid count is now fine and that my T3 and T4 was also in good condition and my TSH was probably low because of being sick.. When I get my physical do they check your TSH anyway? or is it only something they check if you previously tell them you had a case. I mean if i get checked again just to be sure and it comes back fine.. and it was indeed just because i was sick... Is this something that needs to be mentioned at the physical. The way im interpreting this, is I never really had Hyperthyroidism from the get. It was just normal for my tsh to go down from being sick. So therefore I never had nothing more but a bad cold. Any suggestions?

Sounds like you never had it. In my opinion its not worth mentioning. However, there may be a question on the paperwork for the physical that states have you been to a doctor in the last year or somthing as I recall. If so just fess up and take the labs and doc notes from your doctors office and there shouldn't be any problems. (I'd get the records from the doctor and the labs to prove it and take with you to the physical just in case).

[Guest F16crewdwgg]

Sounds like you never had it. In my opinion its not worth mentioning. However, there may be a question on the paperwork for the physical that states have you been to a doctor in the last year or somthing as I recall. If so just fess up and take the labs and doc notes from your doctors office and there shouldn't be any problems. (I'd get the records from the doctor and the labs to prove it and take with you to the physical just in case).

well i'm only a sophmore in college because of engineering.. so betime i take the phsyical, I prob won't be lieing if paperwork asks me if I had been to a doc in the last year.. :) thanks for the advice. -Jeff

[OlAg15]

I’m trying to piggyback on a similar topic. 

After some digging, I have found that most other questions relate to hyper/hypothyroidism.

I got picked up for a flying slot in the air guard and just got sent home from MEPS for enlarged left Thyroid. After blood work and ultrasound, my thyroid function is fine but I do have some nodules. Doc gives 2 options- remove half or possibly whole left side, or leave alone and monitor size every 6 months for 2 years and then yearly after that. My concern with removal is screwing up my T levels and becoming hypo with daily medication when I have a normal functioning endocrine system currently. (26 years old)

Doc says if it was him, leave alone and monitor. But he also figures the military wants the problem to be completely resolved and released prior to commission. 

Any advice or direction to seek advice is greatly appreciated! 

Edited April 18, 2019 by OlAg15
Additional bio information

[OlAg15]

Thank you PilotCandidate for the personal advice. Biggest concern right now is the procedural and paperwork nightmares of the military and how to avoid doing something that is a definite DQ or reduce my chance of getting a waiver.  Doc is not overly concerned on the cancer side but says it is definitely subject to monitor closely. However, the biopsy side was not advisable as there are signs of cysts as well as solid and complex nodules and that a single biopsy could potentially give a false negative. Increase in size would make an easy decision of removal, but military may not accept the option to wait it out.