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.

Baba,
From what I gather from aquaintances with same problem the treatment using carbimazole takes time. On the average it took them 4 to 6 months before they were declared euthyroid after which the go on a reduced dosage and then on a maintenance dose for about a year. One lucky guy's thyroid's problem burnt itself out; the other two's symptoms returned and they were again put on a treatment regime which prepare them eventually to undergo the radio iodine therapy. Hope this help you prepare yourself for frustration as your treatment gets prolonged.

Hi Raj & SpaceNeedle,
Thanks for your helpful posts. Have you any info on the side effects of PTU ( propylthiouracil )? My endocrinologist would not switch me over to PTU unless I stop carbimazole treatment for at least a month; he said that there may be contra indication if the two drugs are mixed.

Babablackship,
Sorry to have caused consternation by removing my post. On reflection it contained personal information that I was not happy to leave on a public website. Also, I thought that others might be tempted to follow my example, which went against medical advice and might be dangerous to another person. :O

Thanks ShyTorque, hope your condition remain great after your self treatment. I will certainly not post any of the stuff from your earlier post. Cheers!:)

Hi guys,
Light at the end of the tunnel. After 3 over months of treatment with carbimazole, my T4 & T3 hormone levels dropped below the upper limits of the respective normal ranges. My endocrinologist is happy to declare me euthyroid and subject to a full physical by the AME, I am good to go as far as my flight status is concerned. The AME indicated that as my bp, ECG, blood tests, vision tests etc are all OK, my class 1 medical status certificate is restored. My thyroid medication and low dose beta blockers are OK for flying. Now comes the other hard part, requalification on the simulator, and line checks! Thanks guys for all your input and advice. To those who do have similar condition, patience is the key word as the treatment and recovery period is indeed protracted. Best wishes to all. Cheers!

BBBS - good luck with it, and continue monitoring. It might be useful if I just mention what happened to me perhaps (I hold a Class 1 with no problem at the moment):

• Hugely hyperthyroid, occurred within a week (but on reflection was using a tank of air quicker than others while diving up to 6 months prior).
• Controlled with Carbimazole & Beta Blockers for three months.
• Encrinologist recommended I-131 (though no idea why it arose, his experience considered it better to eliminate and control at my age).
• Replacement thyroxine daily, but tricky to control, as I have massive thyroxine antibodies in my system for no apparent reason - endocrinologist therefore recommends controlling the TSH (stimulant hormone) rather than the T4 itself.
• Fine now (3 years later), but very sensitive to incorrect dosage.

If you feel incredibly hungover when you are not drinking - it needs sorting.
If you feel irritable, and you argue with your partner - it needs sorting.
If it is not being controlled correctly and you don't feel 100% every day, suggest a TSH blood test.

I have just noticed you said that T4 and TSH were both high - clearly different from my case where they go different directions. I don't think there is much understanding of what actually causes these unfortunately - perhaps random viruses?!

Crvena55

Have only recently joined this forum so I hope you see this post!

Hypothyroidism can have a number of causes, often either the gland is not producing enough hormone despite adequate stimulus from the Hypothalamus (another gland that controls the function of many other glands) or there is not enough stimulation from above.

What has probably happened in your case is that with the abnormal gland producing lots of Thyroxine, the normal production of the stimulating hormones (TRH and TSH) have been suppressed (called negative feedback). Now the abnormal gland has been removed, it will take a while for the TRH and TSH levels to come up, after which time the remaining thyroid tissue will hopefully produce enough hormone to mean that you do not need to take thyroid replacement any more. You may find that your dose just gets smaller. If you are getting any of the symptoms that people have described for hypERthyroidism (essentially everything working too quickly, especially heart, breathing and bowels!) then your dose may need reducing. See your doctor again

Hope that helps

Bob

Bob the Doc ,

Thanks on your reply. Well after my operation my Thyroid gland was working just fine for some 1,5 years, and then when I went to have one check-up, my hormon level was low. So, I started taking medications with seeing my doctor every 2 months, and now my hormon level is ok (but I do take half of one medication every morning). I guess that my situation changed (from my thyroid working ok with one half, to the state when I need to take medication) when I had one really stresfull period in my life, and when I had so much bad things happening to me. And I know that stress is real big enemy of Thyroid gland. I am ok last few months (mening without much stress), and I hope that my hormons will be ok soon, and I still visit my doctor every 2 months.
But if I continue on taking my medication in orded to have my hormones on right lever, is that ok for Cabin Crew? Can I pass medicals with taking medication or any kind of mdication is no-no for Cabin Crew?

Hyperthyroidism
 

Bob the Doc,

Thanks for your reply.
What happened to me is next: I had operation of Thyroid gland in March 2005, and then after operation for some 1,5 year the rest of my gland (2nd half) was doing just fine, without any medications. But then (I guess as a result of really stressfull situations that i had some 8-9 months ago), my thyroid didn't work so fine anymore, so my lever of hormones was less then normal, and I started taking medications. Now my hormon level is ok, but I still take half of medication every morning, and I don't have any side effects (and I see my doctor on regula basis, very 2 months)
So, is it alowed for Cabin Crew to take medication (to keep the lever of hormones normall) or is any kind of medication a big no-no for Emirates?
Thanks :)

crvena55, your condition would probably be a minor case of hypothyroidism brought about by removal of the most active part of your thyroid gland. Well this condition is generally less problematic than hyperthyroidism. As long as it is manageable by medication, you should have no problem as a cabin crew member. The only thing about long haul flying is that you tend to forget to take your medication on time due to time zone differences and fatigue! So you need to work out a reliable medication management routine. All the best.

Reheat, looks like your post comes only after seeing BBBS got better! He would have surely appreciated it had it been earlier.

BBBS, once you had it under control I guess you should look for alternatives as against surgery or radioiodine therapy as Caboclo had suggested.

Yes, unfortunately, but thought someone else may find it of use if searching.

Great thread. I have just been diagnosed with HYPER!. Am off for scans and x-rays soon, before starting the Carbimazole.

Looks like a few months gardening leave whilst hoping for a recovery. I'm a long haul CoJo and am missing it already.

Will keep posting updates.

nurj :}

Get well soon.

Hi nurj, best of luck with your treatment. The scan will indicate whether it is Graves Disease or other thyroid problems. Be prepared for a protracted period of treatment with carbimazole. The posts by Caboclo, Re-Heat, Raj Merlion, SpaceNeedle are especially helpful. Watch out for the side effects of carbimazole which I believe yout endocrinologist will brief you at length.

I am completely euthyroid now and my endocrinologist is slowly weaning me off carbimazole. My thyroid hormone levels are still monitored every month.

Cheers guys, the fact that you flyers are out there, having experienced this 'peculiar' condition, gives me hope. :D


However, if the truth be known, I am feeling particularly miffed as, after 10 years in Big Airways, on the 747-400, my number has come up for an Airbus command, timed for early next year. My thyroid clearly does not fancy all those early starts! problem is, BA requires 6 months of un-interrupted flying prior to a command course.

B*llocks :} All this could not have come at a worse time.

Cheers for now, nurj

..edited to add, off for the scans tomorrow, and x-rays. Am on 50mg of Atenolol to slow my heart rate - AWESOME. No longer do I shake over those 3footers on the greens. :)

..oh, and as for the weight loss, (stone and a half) my wife longs to be hyper!!

..which revealed a 1cm diameter nodule in the left hand lobe of my thyroid gland. Decision day tomorrow.

nurj :}

ENT man suggests a multi-nodular thyroid. On 40mg Carbimazole for 4 weeks to establish a 'modicum' of euthyroidism, then either surgery or radio-iodine treatment. Endocronologist next. Consensus so far that long term Carbimazole not for me given multi-nodular thyroid. Nothing sinister suspected - no need for fine needle aspiration biopsy.
What do you think folks? especially Bob the Doc.
nurj :}

Just had a thought, you guys with hyper had/have Graves, right? Am I the only one with nodules? It seems that thyroid nodules in blokes are much rarer. Am of for an isotope scan this week to track thyroid activity.

Radio-isotope scan showed uniform uptake of iodine. Nowt sinister etc.

Carbimazole to euthyroid, then, hopefully, class 1 back.

Going to consider thyroid removal in 12 months time.

nurj :}

Euthyroid. In to bat with the CAA for my class 1 back. Carbimazole regime continues.

nurj :}