Has anybody had recent experience with the CACI for hyperthyroid? If I'm reading the Guide for Aviation Medical Examiners right, Subclinical Hypothyroidism (<10 TSH, normal T4, asymptomatic, no medication) meets the definition of "No treatment required" and the medical can be issued. If TSH is >10 and/or T4 is abnormal and/or symptomatic and/or medication is required, the CACI applies and the applicant needs the "current, detailed Clinical Progress Note", but the medical can still be issued. It's only if TSH is uncontrolled that OKC needs to get involved.

Just wondering if that lines up with the experience of anyone who's had to deal with this? Here's the link to the FAA document I'm looking at:

Guide for AMEs - https://www.faa.gov/ame_guide/media/...thyroidism.pdf
Hypothyroid CACI - https://www.faa.gov/ame_guide/media/...thyroidism.pdf

 

No. The TSH is uncontrolled if it is 10 or OVER 10, not under 10. TSH is Thyroid Stimulating hormone. If it is 10 or over 10, that means the pituitary is flogging the thyroid trying to get it to produce more.



10 or above and/or symptomatic and the AME has to defer certification to the FAA.

 

Sorry - I guess what I meant was an untreated TSH of 10 or higher, brought down to less than 10 by medication (Synthroid or similar). If an applicant falls under the category of untreated TSH <10, normal T4, no meds, is it reasonable to just report that without further documentation necessary? I'm trying to determine when someone should default to having the "current Clinical Progress Note" in hand at the AME.

 

Basically the AME can’t EVER approve at his/her level unless it can be established that the original diagnosis was due to some temporary cause that is now totally resolved. If they are following the guidelines, a current clinical progress note will be required at least annually for class 2 and 3..

 

It needs to be provided annually for first and second class applicants.

Third class applicants provide with "each required exam," which varies with the age of the applicant.

 

Gotcha, so sounds like even with <10, regardless of T4 and medication, be prepared to provide the note and follow the CACI worksheet. Assuming everything is stable, managed, and the provisions of the CACI worksheet are met are there any pitfalls to be aware of when it's time for the AME visit?

 

Neither the FAA nor the AME (who may be thought of as a sort of designee) are actively TRYING to disqualify you. Nearly 5% of adults have hypothyroidism.
https://magazine.medlineplus.gov/art...n%20in%20women.
In this day and age, it’s generally easy to treat. The big problem with routine medications is compliance. 50% of people on chronic medication don’t take them properly or get proper follow up.
https://www.uspharmacist.com/article...tic%20efficacy.

Call it “due diligence” or just covering their @$$, neither the AME nor the FAA want to take the liability of you being in that 50% on your word alone. It’s nothing personal, it’s just they have seen to many treatment failures due to noncompliance.

if you just show you are getting the appropriate treatment and follow up (even routine medication doses can change with age, weight, and diet), there should be no problem. All the CACI stuff was delegated to the AMEs because it was pretty straightforward and routine - to the point it was really a waste of time for OKC to routinely be involved.