Article

Thyroid Disease at Work: Your ADA and FMLA Rights

How the ADA and FMLA protect workers with hypothyroidism, hyperthyroidism, Hashimoto's disease, Graves' disease, and thyroid cancer, including coverage based on endocrine system functions, symptoms that change while a dose is adjusted, why thyroid hormone and other medicines do not erase coverage, accommodations for fatigue, temperature, concentration, tremor, and eye problems, documentation and medical questions, leave for radioactive iodine or surgery, FMLA, retaliation, and deadlines.

8 min read

How Thyroid Disease Can Qualify as a Disability

Title I of the Americans with Disabilities Act applies to private employers with 15 or more employees for 20 or more weeks in the current or preceding calendar year and to state and local government employers; federal workers are covered through the Rehabilitation Act, and many state laws reach smaller employers. MedlinePlus explains that the thyroid makes hormones that control the way the body uses energy and affect breathing, heart rate, weight, digestion, and moods, and that thyroid diseases cause the gland to make either too much or too little of those hormones. Hypothyroidism, or underactive thyroid, is most often caused by Hashimoto's disease, and hyperthyroidism, or overactive thyroid, is most often caused by Graves' disease; MedlinePlus describes both as autoimmune disorders in which the immune system attacks the thyroid. Under 29 CFR 1630.2(h)(1), a physical impairment includes any physiological disorder or condition affecting a body system, and the endocrine and immune systems are both named. Under 42 U.S.C. Section 12102 and 29 CFR 1630.2(i), major life activities include sleeping, concentrating, thinking, and working, as well as the operation of major bodily functions, including endocrine and immune system functions and the operation of an individual organ within a body system. Coverage is decided individually rather than by diagnosis alone, but the ADA's definition of disability is meant to be construed broadly, and the question is how the condition would limit you compared with most people in the general population.

Changing Symptoms, Dose Adjustments, and Why Treatment Does Not Erase Coverage

MedlinePlus says hypothyroidism symptoms can include fatigue, trouble tolerating cold, joint and muscle pain, and depression, and that because the disease develops slowly, many people do not notice symptoms for months or even years. It lists nervousness or irritability, fatigue, muscle weakness, trouble tolerating heat, trouble sleeping, hand tremor, and a rapid and irregular heartbeat among hyperthyroidism symptoms, and it says many people with Graves' disease have eye problems that can include double vision, and that untreated hyperthyroidism can lead to an eye disease that causes light sensitivity and eye pain. Treatment for hypothyroidism is replacement thyroid hormone, with blood tests about 6 to 8 weeks after starting and after each dose change, and treatment for hyperthyroidism can include antithyroid medicines for 1 to 2 years or longer, beta blockers, radioactive iodine, or surgery; MedlinePlus says almost everyone who has radioactive iodine treatment later develops hypothyroidism, and people whose gland is destroyed or removed need replacement hormone for the rest of their lives. Under 42 U.S.C. Section 12102(4)(E) and 29 CFR 1630.2(j)(1)(vi), the helpful effects of mitigating measures such as medication are ignored, so the fact that daily thyroid hormone keeps your levels in range does not erase coverage, and under 1630.2(j)(1)(vii), an impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active. For thyroid cancer, 29 CFR 1630.2(j)(3)(ii) and (iii) say it should easily be concluded that cancer substantially limits normal cell growth, and under 1630.2(k), a record of a past thyroid condition or cancer that substantially limited a major life activity is also protected.

Accommodations for Fatigue, Temperature, Concentration, Tremor, and Eye Problems

Under 42 U.S.C. Section 12111(9), reasonable accommodation may include job restructuring, part-time or modified work schedules, reassignment to a vacant position, and acquisition or modification of equipment, and the EEOC's reasonable accommodation guidance also treats modifying workplace policies and leave as forms of accommodation. Depending on your symptoms, requests might include a later start time or a modified schedule while your dose is being adjusted, short rest breaks for fatigue or muscle weakness, a workstation away from cold drafts or heat, a fan or heater, or an exception to a uniform rule for heat or cold intolerance, written instructions and fewer interruptions for trouble concentrating, equipment or task changes for a hand tremor, anti-glare screens, lighting changes, or larger text for double vision or light sensitivity, time off for blood tests, radioactive iodine treatment, or surgery, or working from home during a period of severe symptoms, as long as the change does not cause undue hardship, which 29 CFR 1630.2(p) defines as significant difficulty or expense. If more than one accommodation would work, the EEOC says your preference should be given primary consideration, but the employer has the ultimate discretion to choose among effective options, and it is not required to eliminate an essential function of the job or lower a production standard that applies to everyone. If no accommodation would let you perform the essential functions of your current job, reassignment to a vacant position you are qualified for may be required as a last resort.

Weight, Mood, and Being Regarded as Disabled

MedlinePlus lists weight gain and depression among hypothyroidism symptoms and weight loss, mood swings, and irritability among hyperthyroidism symptoms, and it says hyperthyroidism in older adults can sometimes be mistaken for depression or dementia. Under 29 CFR 1630.2(l)(1), you are regarded as having a disability if you are subjected to a prohibited action because of an actual or perceived physical or mental impairment, whether or not the impairment substantially limits a major life activity, and prohibited actions include refusal to hire, demotion, placement on involuntary leave, termination, harassment, and denial of any other term, condition, or privilege of employment. That means an employer that disciplines, demotes, or fires you because a manager assumes a thyroid condition makes you unreliable, emotionally unstable, or unable to keep up may be liable even if your condition would not otherwise count as a disability. Under 29 CFR 1630.15(f), an employer can defend a regarded-as claim only by objectively showing the impairment is both transitory, meaning lasting or expected to last six months or less, and minor, which is difficult for a chronic autoimmune thyroid disease. An employer may still apply the same conduct and performance standards to everyone, which is why asking for an accommodation before symptoms turn into discipline matters.

Documentation, Medical Questions, and Confidentiality

When the need for accommodation is not obvious, the EEOC says an employer may ask for reasonable documentation about the disability and the functional limitations involved, but not for your complete medical records. MedlinePlus says thyroid disease is diagnosed with a medical history, physical exam, and blood tests such as TSH, T3, T4, and thyroid antibody tests, sometimes with imaging, so a note from your endocrinologist or primary care provider describing how your symptoms affect your work, how long a dose adjustment or treatment is expected to take, and what changes you need is usually more useful than lab results or a diagnosis alone. Under 42 U.S.C. Section 12112(d)(4)(A), an employer may not require a medical examination of a current employee or ask about the nature or severity of a disability unless the examination or inquiry is job-related and consistent with business necessity. Under 42 U.S.C. Section 12112(d) and 29 CFR 1630.14, medical information an employer obtains must be kept in separate, confidential medical files, and supervisors may be told only about necessary work restrictions and accommodations. The EEOC also says reasonable accommodation is always prospective, so it helps to make your request in writing before symptoms turn into missed shifts or discipline.

FMLA Leave for Treatment, Surgery, and Appointments

Under 29 CFR 825.110, an eligible employee has worked for the employer for at least 12 months, has at least 1,250 hours of service in the 12 months before leave starts, and works at a location where the employer has at least 50 employees within 75 miles, and eligible employees can generally take up to 12 workweeks of job-protected leave in a 12-month period. Under 29 CFR 825.114, inpatient care means an overnight stay in a hospital, including any resulting period of incapacity and later treatment, which can cover thyroid surgery that involves an overnight stay. Under 29 CFR 825.115(c), a chronic serious health condition is one that requires periodic visits, at least twice a year, for treatment by a health care provider, continues over an extended period of time, and may cause episodic rather than continuing periods of incapacity, and under 825.115(f), an absence for such a condition can qualify even if you do not see a provider during that particular absence. Under 29 CFR 825.202, FMLA leave may be taken intermittently or on a reduced leave schedule when medically necessary, which can cover recurring endocrinology visits and blood tests, radioactive iodine treatment, recovery from surgery, or days when symptoms flare while your treatment is adjusted. Even if you are not eligible for FMLA, unpaid leave can also be a reasonable accommodation under the ADA.

Retaliation and Deadlines

Under 42 U.S.C. Section 12203, an employer may not retaliate against you for requesting an accommodation, opposing disability discrimination, or taking part in an ADA charge or investigation, or coerce, intimidate, threaten, or interfere with you for exercising ADA rights, and under 29 U.S.C. Section 2615, an employer may not interfere with FMLA rights or discriminate against you for using protected leave. Keep a written record of your accommodation requests, each response, any comments about your weight, mood, energy, or condition, and any discipline, schedule change, or termination that follows, including dates and the names of the people involved. A charge with the EEOC generally must be filed within 180 calendar days of the discriminatory act, extended to 300 days where a state or local agency enforces a law prohibiting the same kind of discrimination; federal employees generally must contact an agency EEO counselor within 45 days. FMLA claims do not go through the EEOC and have their own deadlines, so it helps to get advice from an employment lawyer early.

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