Hypothyroidism
What the FAA's documents say about hypothyroidism, in plain words, with the FAA's own words one press away.
FAA term: Hypothyroid or Hypothyroidism (Including Hashimoto's Disease)
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AResolved, no treatment required | Examiner issues | Examiner can issue |
| Row BPrimary hypothyroidism | Worksheet | CACI |
| Row CPrimary hypothyroidism; symptomatic; TSH 10 mIU/L or higher; central | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Hypothyroidism
- Row A · Examiner can issue
Resolved, with no treatment required. The table says ISSUE if the examiner is able to determine through history and exam no treatment necessary, no symptoms, and no clinical concern, and has the examiner annotate this information in Block 60.
A. Resolved No treatment required … If the AME is able to determine through history and exam no treatment necessary, no symptoms, and no clinical concern: ISSUE Annotate this information in Block 60.
- Row B · CACI
Primary hypothyroidism. The table sends the examiner to the CACI worksheet for hypothyroidism, and says this will require a current, detailed clinical progress note from a clinic visit with the treating physician no more than 90 days before the exam, and a TSH. The examiner issues with no time limitation if the pilot meets all the worksheet's criteria and is otherwise qualified, annotates the correct CACI statement in Block 60, and keeps the required supporting information on file.
B. Primary Hypothyroidism See the CACI - Hypothyroidism Worksheet. This will require a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND TSH. … If the pilot meets all CACI worksheet criteria and is otherwise qualified, ISSUE with no time limitation … Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
The row names primary hypothyroidism, symptomatic, TSH 10 mIU/L or higher, and central hypothyroidism (due to pituitary or hypothalamic disease). The examiner submits the listed items for FAA review, defers, and submits the information to the FAA for a possible Special Issuance.
C. Primary Hypothyroidism Symptomatic TSH 10 mIU/L or higher Central Hypothyroidism (Due to pituitary or hypothalamic disease) … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
The FAA pathways for hypothyroidism
- How this pathway works: Examiner can issueNo special pathwayRow A
- How this pathway works: CACIConditions AMEs Can IssueRow B
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateRow C
- How this pathway works: AASIAME Assisted Special IssuanceAfter the FAA decides
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The progress note and a TSH
What the table says the CACI row will require.Progress note
Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician, no more than 90 days before the exam.
TSH
A TSH, beside the progress note.
The worksheet
- A TSH less than 10 within the last one year
10 or higher must be deferred.
The table's note
As of 1/25/2023, a TSH up to 9.9 can be considered for CACI if other criteria are met.
Show the FAA's words: The progress note and a TSH
See the CACI - Hypothyroidism Worksheet. This will require a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND TSH.
FAA source: Hypothyroidism Disposition Table. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days before the AME exam.
FAA source: CACI – Hypothyroidism Worksheet. FAA date 28 June 2023; checked by Crosscheck 14 October 2026.
This will require a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND TSH.
FAA source: Hypothyroidism Disposition Table. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
Note: As of 1/25/2023, TSH up to 9.9 can be considered for CACI if other criteria are met.
FAA source: Hypothyroidism Disposition Table. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
TSH less than 10 (uIU/mL or mlU/L) within the last one year (10 or higher must be deferred) [ ] Yes
FAA source: CACI – Hypothyroidism Worksheet. FAA date 28 June 2023; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
What the treating physician finds, your symptoms, medications and TSH.The CACI worksheet's criteria, which your AME reviews.
The treating physician finds
- The condition stable
Symptoms and signs: none of
- Not: Fatigue
- Not: Mental status impairment
- Not: Symptoms related to pulmonary, cardiac, or visual systems
Acceptable medications
- Levothyroxine sodium (Synthroid, Levothyroid)
- Porcine thyroid (Armour)
- Liothyronine sodium (Cytomel)
- Liotrix (Thyrolar)
Show the FAA's words: The worksheet's criteria
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Treating physician finds the condition stable [ ] Yes
FAA source: CACI – Hypothyroidism Worksheet. FAA date 28 June 2023; checked by Crosscheck 14 October 2026.
Symptoms and signs [ ] None of the following: fatigue, mental status impairment, or symptoms related to pulmonary, cardiac, or visual systems
FAA source: CACI – Hypothyroidism Worksheet. FAA date 28 June 2023; checked by Crosscheck 14 October 2026.
Acceptable medications [ ] Levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel), or liotrix (Thyrolar)
FAA source: CACI – Hypothyroidism Worksheet. FAA date 28 June 2023; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE if the examiner is able to determine through history and exam no treatment necessary, no symptoms, and no clinical concern, and has the examiner annotate this information in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for hypothyroidism, and says this will require a current, detailed clinical progress note from a clinic visit with the treating physician no more than 90 days before the exam, and a TSH. The examiner issues with no time limitation if the pilot meets all the worksheet's criteria and is otherwise qualified, annotates the correct CACI statement in Block 60, and keeps the required supporting information on file.
Row CDefers to the FAASpecial Issuance
The examiner submits the listed items for FAA review, defers, and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Resolved, with no treatment required. The table says ISSUE if the examiner is able to determine through history and exam no treatment necessary, no symptoms, and no clinical concern, and has the examiner annotate this information in Block 60.
A. Resolved No treatment required … If the AME is able to determine through history and exam no treatment necessary, no symptoms, and no clinical concern: ISSUE Annotate this information in Block 60.
- Row B · CACI
Primary hypothyroidism. The table sends the examiner to the CACI worksheet for hypothyroidism, and says this will require a current, detailed clinical progress note from a clinic visit with the treating physician no more than 90 days before the exam, and a TSH. The examiner issues with no time limitation if the pilot meets all the worksheet's criteria and is otherwise qualified, annotates the correct CACI statement in Block 60, and keeps the required supporting information on file.
B. Primary Hypothyroidism See the CACI - Hypothyroidism Worksheet. This will require a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND TSH. … If the pilot meets all CACI worksheet criteria and is otherwise qualified, ISSUE with no time limitation … Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
The row names primary hypothyroidism, symptomatic, TSH 10 mIU/L or higher, and central hypothyroidism (due to pituitary or hypothalamic disease). The examiner submits the listed items for FAA review, defers, and submits the information to the FAA for a possible Special Issuance.
C. Primary Hypothyroidism Symptomatic TSH 10 mIU/L or higher Central Hypothyroidism (Due to pituitary or hypothalamic disease) … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
The CACI worksheet's criteria
TSH
- A TSH less than 10 within the last one year
10 or higher must be deferred.
The worksheet's criteria
The treating physician finds
- The condition stable
Symptoms and signs: none of
- Not: Fatigue
- Not: Mental status impairment
- Not: Symptoms related to pulmonary, cardiac, or visual systems
Acceptable medications
- Levothyroxine sodium (Synthroid, Levothyroid)
- Porcine thyroid (Armour)
- Liothyronine sodium (Cytomel)
- Liotrix (Thyrolar)
Show the FAA's words: the CACI worksheet's criteria for Hypothyroidism
- Stable
FAA criterion: the treating physician finds the condition stable.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA … Treating physician finds the condition stable [ ] Yes
- None of the symptoms and signs the worksheet lists
FAA criterion: under symptoms and signs, none of the following: fatigue, mental status impairment, or symptoms related to pulmonary, cardiac, or visual systems.
Symptoms and signs [ ] None of the following: fatigue, mental status impairment, or symptoms related to pulmonary, cardiac, or visual systems
- The acceptable medications the worksheet lists
FAA criterion: acceptable medications are levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel), or liotrix (Thyrolar).
Acceptable medications [ ] Levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel), or liotrix (Thyrolar)
- TSH less than 10 within the last one year
FAA criterion: a TSH less than 10 (uIU/mL or mlU/L, as printed) within the last one year. The worksheet says 10 or higher must be deferred.
TSH less than 10 (uIU/mL or mlU/L) within the last one year (10 or higher must be deferred) [ ] Yes
If the examiner defersSpecial Issuance
The table's row C names primary hypothyroidism, symptomatic, TSH 10 mIU/L or higher, and central hypothyroidism (due to pituitary or hypothalamic disease). The table marks it DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note generated from a clinic visit with the treating physician performed no more than 90 days before the exam. The table says a diagnosis of central hypothyroidism should be evaluated by an endocrinologist, and that the note must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.
- Item 2. Lab performed within 90 days of the exam, to include a thyroid stimulating hormone (TSH) and any other lab already performed by the treating physician (for example T3 or free T4).
- Item 3. Copies of any imaging reports (MRI, CT, ultrasound, X-ray) already performed. The table says to submit the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named 'DICOMDIR' in the root directory of the CD-ROM; to verify the CD will display the images before sending; and to retain a copy of all films as a safeguard if lost in the mail.
- Item 4. Any other testing deemed clinically necessary by the treating physician.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's row C names primary hypothyroidism, symptomatic, TSH 10 mIU/L or higher, and central hypothyroidism (due to pituitary or hypothalamic disease). The table marks it DEFER.
C. Primary Hypothyroidism Symptomatic TSH 10 mIU/L or higher Central Hypothyroidism (Due to pituitary or hypothalamic disease) … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A current, detailed clinical progress note generated from a clinic visit with the treating physician performed no more than 90 days before the exam. The table says a diagnosis of central hypothyroidism should be evaluated by an endocrinologist, and that the note must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.
A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician performed no more than 90 days before the AME exam. (Diagnosis of Central Hypothyroidism should be evaluated by an endocrinologist.) It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.
- Item 2
Lab performed within 90 days of the exam, to include a thyroid stimulating hormone (TSH) and any other lab already performed by the treating physician (for example T3 or free T4).
Lab: Performed within 90 days of the AME exam to include: … Thyroid Stimulating Hormone (TSH), and … Any other lab already performed (Ex. T3, Free T4) by the treating physician.
- Item 3
Copies of any imaging reports (MRI, CT, ultrasound, X-ray) already performed. The table says to submit the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named 'DICOMDIR' in the root directory of the CD-ROM; to verify the CD will display the images before sending; and to retain a copy of all films as a safeguard if lost in the mail.
Imaging: Copies of any imaging reports (MRI, CT, ultrasound, X-ray) already performed. … Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.
- Item 4
Any other testing deemed clinically necessary by the treating physician.
Any other testing deemed clinically necessary by the treating physician.
After the FAA decides
AASIThe FAA's AASI sheet for hypothyroidism says an FAA physician provides the initial certification decision and grants the Authorization, and that for a first-time AASI application, with all the medical information needed for a determination, the examiner must defer and submit all of it to the AMCD or RFS for the initial determination. After that, the sheet says the examiner may reissue under the Authorization when the pilot provides what it lists.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401 . … If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination. … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the FAA's AASI sheet for hypothyroidism lists what the pilot provides for the examiner to reissue. That is the Authorization granted by the FAA; the name and dosage of medication(s) used for treatment and/or prevention, with comment regarding side effects; a statement regarding any other associated problems, such as cardiac or visual; and a statement regarding the current thyroid stimulating hormone (TSH) level performed within the last 90 days. The sheet says the Authorization letter comes with attachments that specify the information the treating doctors must provide for the reissue determination.
Show the FAA's words: at later exams
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; … A statement regarding any other associated problems, such as cardiac or visual; and … A statement regarding the current thyroid stimulating hormone (TSH) level performed within last 90 days.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI sheet's first item for a reissue is an Authorization granted by the FAA.
Show the FAA's words: The Authorization granted by the FAA
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
The name and dosage of medication, with comment on side effects
For a reissue the AASI sheet asks for the name and dosage of medication(s) used for treatment and/or prevention, with comment regarding side effects.
Show the FAA's words: The name and dosage of medication, with comment on side effects
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects;
A statement on any other associated problems
For a reissue the AASI sheet asks for a statement regarding any other associated problems, such as cardiac or visual.
Show the FAA's words: A statement on any other associated problems
A statement regarding any other associated problems, such as cardiac or visual; and
A statement on the current TSH level
For a reissue the AASI sheet asks for a statement regarding the current thyroid stimulating hormone (TSH) level performed within the last 90 days.
Show the FAA's words: A statement on the current TSH level
A statement regarding the current thyroid stimulating hormone (TSH) level performed within last 90 days.
What the Authorization letter comes with
The AASI sheet says the Authorization letter comes with attachments that specify the information the treating doctors must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI sheet says the examiner must defer to the AMCD or Region if the pilot develops a related problem in another system, such as cardiac, or if the TSH level is elevated. The sheet gives no figure for elevated.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … The applicant develops a related problem in another system, such as cardiac; or … The TSH level is elevated.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Where the TSH figures fall
The table's note says a TSH up to 9.9 can be considered for CACI if other criteria are met. Its row C, marked DEFER, names a TSH of 10 mIU/L or higher. The worksheet asks for a TSH less than 10 within the last one year, and says 10 or higher must be deferred.
Show the FAA's words: good to know, 2
Note: As of 1/25/2023, TSH up to 9.9 can be considered for CACI if other criteria are met. … TSH 10 mIU/L or higher … DEFER Submit the information to the FAA for a possible Special Issuance.
TSH less than 10 (uIU/mL or mlU/L) within the last one year (10 or higher must be deferred)
Central hypothyroidism goes to an endocrinologist
For row C, the table says a diagnosis of central hypothyroidism should be evaluated by an endocrinologist.
Show the FAA's words: good to know, 3
(Diagnosis of Central Hypothyroidism should be evaluated by an endocrinologist.)
Imaging goes on a CD
For row C, the table asks for the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named 'DICOMDIR' in the CD's root directory.
Show the FAA's words: good to know, 4
Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM).
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Hypothyroidism Worksheet, a PDF at the FAA, in a new tab
- Hypothyroidism Disposition TableOpen to print: Hypothyroidism Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open to print: AASI – Hypothyroidism, a page at the FAA, in a new tab
- Open at the FAA: Hypothyroidism (Item 48, endocrine), a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
Medication guidance
Medications Crosscheck lists as taken for hypothyroidism, each with its own page on what published FAA guidance says about it.
- Acceptable medication on the FAA's hypothyroidism worksheet
- Acceptable medication on the FAA's hypothyroidism worksheet
- Acceptable medication on the FAA's hypothyroidism worksheet
- Acceptable medication on the FAA's hypothyroidism worksheet
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.