Hypothyroidism Worksheet

Checklist for AMEs Treating Pilots with Hypothyroidism

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide page 158, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

The Examiner must review a current status report by the treating physician and any supporting documents to determine the applicant's eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

Hypothyroidsm Worksheet





Treating physician finds the condition stable on current regimen and no changes recommended

[ ] Yes

Symptoms and signs

[ ] None of the following: fatigue, mental status impairment, or symptoms related to pulmonary, cardiac, or visual systems

Acceptable medications

[ ] Levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel), or liotrix (Thyrolar)

Normal TSH within the last 90 days

[ ] Yes

AME MUST NOTE in Block 60 one of the following:

[ ] Airman meets certification criteria for hypothyroidism.

[ ] Airman had a previous Special Issuance for this condition and now meets the regular issuance certification criteria for hypothyroidism.

[ ] Airman does NOT meet certification criteria for hypothyroidism. I have deferred this exam. (Mail the supporting documents to FAA identifying which criteria were not met.)

2013 Version of this Hypothyroidism Worksheet also available as PDF

This page discussed Hypothyroidism Worksheet

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