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FAA CACI Hypothyroidism Worksheet for Pilots

Pilots treated for hypothyroidism can be certified in the AME's office through this Conditions AMEs Can Issue (CACI) checklist. The AME reviews the treating physician's or specialist's progress note from a visit no more than 90 days before the exam and confirms each criterion: stable condition, no qualifying symptoms, an accepted medication and a TSH under 10 within the last year. If every box is met, the AME issues.

Who completes it

The AME completes the checklist and marks one of three Block 60 outcomes. The treating physician, endocrinologist or other specialist supplies the current, detailed Clinical Progress Note that the AME checks it against.

Submitting and payment

How to submit it
A CACI-qualified case is noted in Block 60 of FAA Form 8500-8 and the documents do not need to be submitted to the FAA. If any criterion is not met, the AME defers and submits the supporting documents.

Good to know

  • Accepted medications are levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel) or liotrix (Thyrolar); the note should name the one the pilot takes.
  • TSH must be under 10 uIU/mL (mIU/L) within the last year. A TSH of 10 or higher must be deferred, so the note should give the latest value and date.
  • The note should state there is no fatigue, mental status impairment, or symptoms involving the pulmonary, cardiac or visual systems.
  • First- and second-class applicants provide the information annually and third-class applicants with each required exam. Pilots with a current or previous SI/AASI can be marked as now CACI qualified.

Get the official form

Download the current version from the source each time; forms change without notice.

CACI - Hypothyroidism Worksheet

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What TSH level does the FAA accept for the hypothyroidism CACI?

The worksheet requires a TSH less than 10 uIU/mL (mIU/L) within the last year. A value of 10 or higher means the AME must defer the exam and send the supporting documents to the FAA rather than issue in the office. The treating clinician's note should give the most recent TSH result and its date.

Which thyroid medications qualify for the FAA hypothyroidism CACI?

The checklist lists levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel) and liotrix (Thyrolar). The treating physician must also find the condition stable and the pilot free of fatigue, mental status impairment and pulmonary, cardiac or visual symptoms.

Does the AME send the hypothyroidism CACI to the FAA?

Not when the pilot qualifies. The AME notes 'CACI qualified hypothyroidism' in Block 60 and keeps the documents; they do not need to be submitted. If the pilot does not meet every item, the AME defers and submits the supporting documents for FAA review.