Hyperthyroidism

Overview of Medical Evaluation

The treating endocrinologist or other treating physician knowledgeable regarding management of hyperthyroidism should provide the police physician with relevant medical records, medical data and/or responses to specific questions that indicate whether the LEO has met the criteria set out below.

LEO Evaluation

LEOs with hyperthyroidism can be cleared for full duty if they meet all the following criteria:

• Currently euthyroid (TSH in physiological range)
• No diplopia or decreased visual acuity (Graves’ ophthalmopathy)
• No cardiovascular, mental health or musculoskeletal manifestations
• Compliance with treatment plan, which should include TSH levels done at least annually.

Short-term restrictions will depend on the specific physical demands of their job. If there are significant physical demands, short-term restriction may be necessary until the LEO is euthyroid. This may take up to 6-8 weeks, but improvement may be apparent as early as 4 weeks post therapy. The police physician may use training activities to evaluate the LEO if there are unresolved questions on the LEO’s ability to perform strenuous essential job functions.

LEOs who have been diagnosed with hyperthyroidism, but who are not currently euthyroid, may need restrictions depending on the following manifestations (see relevant LEO chapters):

Cardiovascular

• Atrial fibrillation or flutter
• Tachycardia
• Heart failure
• Hypertension

Vision

• Diplopia
• Changes in visual acuity

Mental Health

• Impairment of cognition or judgment
• Anxiety, psychotic symptoms, bi-polar disorder (mania or depression)

Musculoskeletal Manifestations

• Proximal muscle weakness
• Paralysis
• Tremor

If radioactive iodine (RAI) is used to treat the hyperthyroidism, restrictions may be necessary for 2-5 days (depending on the dose used) since the LEO may come into contact with children or pregnant women.

Follow up and monitoring 4-6 weeks after therapy (RAI, medication, or surgery) needs to done as the LEO can become hypothyroid and require levothyroxine replacement therapy.

All medications used should be evaluated per the Medications chapter.