for
HYPOTHYROIDISM
Developed for the
Aerospace Medical Association
by their constituent organization
American Society of Aerospace Medicine Specialists
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.
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.
Treatment and
Aeromedical Disposition: Initial waiver requires endocrine consultation and
confirmation of euthyroid status. Annual renewal requires confirmation of
euthyroid status. These would be the same requirements for civil airmen. Unless there was some unusual presentation,
civil airmen would be required to demonstrate a euthyroid state yearly for
First and Second class airmen and with each examination for Third class.
Experience: 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. In
the U.S.A.F. as of March 1997, 169 rated officers had received waivers
for treated hypothyroidism.
In
the FAA as of 2008 there are currently issued 1,521 first-, 1,579 second-, and 4,321
third-class airmen with hypothyroidism.
References:
Rayman,
Russell B., Clinical Aviation Medicine, 2nd Edition, Lea
& Febiger, Philadelphia, 1990, p. 49.
Scientific American Medicine. CD ROM (SAM-CD) 1997;3(1):21-7.
July
22, 2008