Hyperthyroidism
 

I have been diagnosed with a hyperactive thyroid. Scan by endocrinologist has confirmed it as Graves Disease; he has prescribed antithyroid drug carbimazole and beta blockers. However progress is slow; he has suggested radioactive iodine treatment if present therapy does not work. He is confident that my flying status will not be affected after radioiodine treatment. Would certainly appreciate any input, advice or prior experience with this condition by fellow ppruners.

hyperthyroidism
 

I know of 2 airline pilots with previous history of hyperactive thyroid leading to Graves Disease. One had the thyroid surgically removed and the other had radio iodine therapy. Their conditions stabilised sufficiently for them to return to airline flying. The one with the thyroid surgically removed had to take thyroid hormones for the rest of his life. The more fortunate chap who had radio iodine therapy need no further medication. I can't tell why but his thyroid was not totally destroyed and it still produce sufficient thyroid hormones to sustain normal function. Hope this info helps. Good luck...Jetney

Hi Baba, management of Graves disease is usually pretty straightforward, although a little protracted.

Three treatment options are available, drugs, radioiodine and surgery.

From what I've seen, treatments tend to be very successful, but usually "overdo" things slightly, resulting in the need for replacement thyroid hormones eventually. (It's likely that you will have to take a thyroid tablet daily for the rest of your life, and have your blood levels monitored every year or so.)

I guess that your physician is adopting a "wait and see" approach, which is reasonable.

Obviously you need to discuss things with your AME, but Jetney's post suggests that this shouldn't pose too many problems.

Hyperthyroidism can often cause problems with the eye's, and from a pilot's point of view, I guess that it is essential that your symptoms are monitored very closely at this stage, and it may be worth gently reminding your endocrinologist of the importance for a man in your position.

Keep us informed:)

hyperthyroidism
 

Would love to provide more info, but lost contact with the 2 guys. Hope there a more guys out there who can share relevant info.

Many thanks for the info. Will be talking to AME soon .

Most doctors reckon that it is better for patient to be hypothyroid that hyperthyroid; so they normally recommend radioiodine therapy to kill off the thyroid gland and then manage the " hypo " condition with thyroxin. As long as your condition is stabilised and your blood tests indicate normal T3/T4 hormone levels, I suppose you can fly as a flight crew. If not, class 1 medical will be denied. Hope this helps but mind you, I am not an AME !

Hi baba,
Carbimazole can cause a severe drop in white blood cells making you susceptible to bacterial infection. A family member had this unfortunate reaction called agranulocytosis; he had to discontinue carbimazole therapy. He was then prescribed propythiouracil which eventually controlled his condition. The down side, he has to remain on a maintenance dosage as his hyperthyroid condition returned as soon as he stopped taking the drug. He is not a pilot so no problem. However I did remember hearing about loss of flying status if one's thyroid had been surgiclly removed. Any one with more info on this?

As far as I know, one cannot fly if you have an overactive thyroid. Whether through surgery or radio iodine therapy should one's condition return to normal euthyroid condition I see no reason why one cannot fly. One will most likely be hypothyroidic after surgery or radio iodine therapy, so will be on thyroxin medication to maintain normal function.

Hi ShyTorque,
Certainly glad you're fine after that unorthodox self treatment; how brave! Well, I only lost 6kg in 2.5 months and fortunately, I had no throat infections, headaches, hand tremors, goitre or blurred vision. I had occasional mild indigestion, 2 to 3 bowel movements daily with loose stools, elevated blood pressure ( 160/110, sitting down ) and a racy pulse ( 80 to 150 at rest and 110 to 190 with light to moderate activity ). The company doctor diagnosed my condition as pre -hypertensive state going to a full hypertension. My family doctor recognised the condition as early stage hyperthyroidism, but sent me to a cardiologist to rule out cardiovascular disease. After an echo-cardio scan and tests, he ascertained my ticker as fine. Next the endocrinologist diagnosed the problem as hyperthyroidism and Graves disease was confirmed after a thyroid scintographic scan. The anti-thyroid drug carbimazole and the beta blocker metoprolol were prescribed, but my condition improved ever so slowly. Despite sticking religiously to the medication schedule and dosage, my T4 and T3 hormone levels initially came down to just above the upper limit of mormal range and for some reasons that puzzled my endocrinologist, they shot up again. The dosage was then increased to almost 80% of the maximum, but the hormone levels still hover a couple of units above the upper limit of the normal range. The therapy had gone on for about 2 months and it is indeed frustrating to see early improvement only to see a regression.

Oops, what happened to ShyTorque's post?

Baba, what are talking about? Did ShyTorque post anything here? Maybe the moderators removed it for PC reasons.

Hi ShyTorque,
Were floating a red herring or winding up poor Baba? I had a fleeting glimpse of your post and thought of coming to it back later only to discover that it's gone!

If it's true, what a way to wind somebody up...this is a medical & health forum!

Hawk, many thanks for the clarification. As for Baba, maybe you can post the gist of what he posted and let us share his wisdom.

Hi Raj, thanks for your posts. ShyTorque alluded to some unorthodox approach which helped him tackle Graves Disease. Now that he has removed his post, he might have good reasons to do so. As such, I respect his desire not keep the post public in this forum and hence I will not repeat it here.Furthermore I did not save or print out his post, and in my condition the memory ain't too good. I hope others can share their experience with fellow sufferers of this frustrating condition.

I have Graves, and, like Baba, I also felt considerable frustration with the delay in the meds taking effect. In my case, I was grounded for about 8 months before my thyroid finally got back to normal. I'm currently still on the pills; my doctor is recommending the radioactive iodine treatment, but I'm putting it off. The iodine treatment is kind of "horseshoes and hand-grenades" in that it is not extremely precise. The objective is to kill off part, but not all of the gland. The lucky ones no longer have to take any meds, the others might need a small dose of one or the other, depending on whether the iodine treatment was a little too much or too little. I can't speak for the Euro authorities, but from the FAA's standpoint, the disease is not too serious; as long as the blood test shows the thyroid function is within the normal range and there are no side effect to the meds, then you're good to go. According to my AME, the FAA does not object to a one time treatment with the radioactive iodine, but if the condition requires continued doses of radiation, then the medical certificate would be suspended until the treatment is complete. Do some web surfing and you'll find lots of horror stories about the radiation treatment, and a very wide range of "alternative" treatments; there are those who believe the entire medical profession are quacks, and prefer to self-medicate with large quantites of "natural supplements" rather than take one pill prescribed by the establishment. On the one hand, the thyroid treatment uses a much smaller dosage of radiation than, say, cancer treatment. It's an outpatient procedure, with mild nausea being the only immediate side effect. On the other hand, radiation in any dose is serious stuff, and should not be undertaken lightly.

Many thanks Caboclo for sharing. My endocrinologist has also advised radioiodine therapy as one of the last resorts. It has been a frustrating two and a half months watching my T4 and T3 levels fluctuating up and down, puzzling even my endocrinologist. I still have a racy pulse and 2 to 3 bowel movements a day but I have regained some of the weight lost.

Keep in mind, Baba, that radioiodine therapy is a well-established treatment that has been around for quite a long time. Sure, nothing's guaranteed these days, but the safety and effectiveness are well known, and are certainly less than the disease itself.
Though it isn't my field of expertise, I dealt with a number of patients who had the I-131 treatment, and don't recall any major problems.
Personally, if all was equal, I'd choose the cocktail over the surgery.
I would follow the advice of your endocrinologist regarding your specific case.